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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8557.27,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14441.36,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18912.18,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12310.05,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8442.86,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2443.01,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc","code_information":[{"code":"066","type":"MS-DRG"}],"standard_charges":[{"minimum":5721.98,"maximum":14811.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14811.57,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5721.98,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12376.69,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6222.78,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6115.99,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Transient Ischemia Without Thrombolytic","code_information":[{"code":"069","type":"MS-DRG"}],"standard_charges":[{"minimum":5929.37,"maximum":6254.52,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6254.52,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5929.37,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Nonspecific Cerebrovascular Disorders With Cc","code_information":[{"code":"071","type":"MS-DRG"}],"standard_charges":[{"minimum":10089.01,"maximum":10089.01,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10089.01,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cranial And Peripheral Nerve Disorders Without Mcc","code_information":[{"code":"074","type":"MS-DRG"}],"standard_charges":[{"minimum":13310.11,"maximum":13310.11,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13310.11,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Traumatic Stupor And Coma >1 Hour With Mcc","code_information":[{"code":"082","type":"MS-DRG"}],"standard_charges":[{"minimum":33221.4,"maximum":33221.4,"setting":"inpatient","payers_information":[{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":33221.4,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Disorders Of Nervous System With Mcc","code_information":[{"code":"091","type":"MS-DRG"}],"standard_charges":[{"minimum":2257.64,"maximum":12811.12,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12811.12,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2257.64,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Disorders Of Nervous System With Cc","code_information":[{"code":"092","type":"MS-DRG"}],"standard_charges":[{"minimum":7176.16,"maximum":7176.16,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7176.16,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Disorders Of Nervous System Without Cc/Mcc","code_information":[{"code":"093","type":"MS-DRG"}],"standard_charges":[{"minimum":5572.74,"maximum":8621.95,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8621.95,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5572.74,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc","code_information":[{"code":"096","type":"MS-DRG"}],"standard_charges":[{"minimum":12677.89,"maximum":12677.89,"setting":"inpatient","payers_information":[{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12677.89,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Seizures With Mcc","code_information":[{"code":"100","type":"MS-DRG"}],"standard_charges":[{"minimum":13357.11,"maximum":13357.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13357.11,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Seizures Without Mcc","code_information":[{"code":"101","type":"MS-DRG"}],"standard_charges":[{"minimum":1200.0,"maximum":11886.78,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11886.78,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7015.7,"methodology":"other"},{"payer_name":"PHCS","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":1200.0,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Headaches Without Mcc","code_information":[{"code":"103","type":"MS-DRG"}],"standard_charges":[{"minimum":5791.87,"maximum":12234.27,"setting":"inpatient","payers_information":[{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12234.27,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7558.79,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5791.87,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Neurological Eye Disorders","code_information":[{"code":"123","type":"MS-DRG"}],"standard_charges":[{"minimum":8819.2,"maximum":8819.2,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8819.2,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Salivary Gland Procedures","code_information":[{"code":"139","type":"MS-DRG"}],"standard_charges":[{"minimum":9964.51,"maximum":9964.51,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9964.51,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc","code_information":[{"code":"148","type":"MS-DRG"}],"standard_charges":[{"minimum":7892.38,"maximum":7892.38,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7892.38,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Dysequilibrium","code_information":[{"code":"149","type":"MS-DRG"}],"standard_charges":[{"minimum":4755.12,"maximum":7139.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4755.12,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7139.52,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Otitis Media And Uri With Mcc","code_information":[{"code":"152","type":"MS-DRG"}],"standard_charges":[{"minimum":7928.89,"maximum":68514.13,"setting":"inpatient","payers_information":[{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":68514.13,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7928.89,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Otitis Media And Uri Without Mcc","code_information":[{"code":"153","type":"MS-DRG"}],"standard_charges":[{"minimum":2650.86,"maximum":3599.54,"setting":"inpatient","payers_information":[{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3599.54,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2650.86,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc","code_information":[{"code":"156","type":"MS-DRG"}],"standard_charges":[{"minimum":3911.2,"maximum":3911.2,"setting":"inpatient","payers_information":[{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3911.2,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Dental And Oral Diseases With Cc","code_information":[{"code":"158","type":"MS-DRG"}],"standard_charges":[{"minimum":6701.73,"maximum":6701.73,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6701.73,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Chest Procedures Without Cc/Mcc","code_information":[{"code":"165","type":"MS-DRG"}],"standard_charges":[{"minimum":14404.04,"maximum":14404.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14404.04,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Respiratory System O.R. Procedures With Cc","code_information":[{"code":"167","type":"MS-DRG"}],"standard_charges":[{"minimum":11008.37,"maximum":38344.33,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15059.38,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":38344.33,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11008.37,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Respiratory System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"168","type":"MS-DRG"}],"standard_charges":[{"minimum":10667.74,"maximum":10667.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10667.74,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism","code_information":[{"code":"173","type":"MS-DRG"}],"standard_charges":[{"minimum":22295.64,"maximum":97327.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":97327.97,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23452.87,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":83470.06,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22295.64,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Pulmonary Embolism With Mcc Or Acute Cor Pulmonale","code_information":[{"code":"175","type":"MS-DRG"}],"standard_charges":[{"minimum":10161.32,"maximum":11356.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11356.89,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10161.32,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Pulmonary Embolism Without Mcc","code_information":[{"code":"176","type":"MS-DRG"}],"standard_charges":[{"minimum":6594.85,"maximum":7161.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7161.93,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6594.85,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Respiratory Infections And Inflammations With Mcc","code_information":[{"code":"177","type":"MS-DRG"}],"standard_charges":[{"minimum":12134.89,"maximum":20946.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12864.44,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20946.02,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12134.89,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Respiratory Infections And Inflammations With Cc","code_information":[{"code":"178","type":"MS-DRG"}],"standard_charges":[{"minimum":7906.42,"maximum":8474.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7906.42,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8474.45,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Respiratory Infections And Inflammations Without Cc/Mcc","code_information":[{"code":"179","type":"MS-DRG"}],"standard_charges":[{"minimum":3741.89,"maximum":6868.72,"setting":"inpatient","payers_information":[{"payer_name":"Georgia Assurance","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5657.39,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6868.72,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3741.89,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Respiratory Neoplasms With Mcc","code_information":[{"code":"180","type":"MS-DRG"}],"standard_charges":[{"minimum":7051.53,"maximum":7051.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7051.53,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Respiratory Neoplasms With Cc","code_information":[{"code":"181","type":"MS-DRG"}],"standard_charges":[{"minimum":18856.19,"maximum":18856.19,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18856.19,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Chest Trauma With Cc","code_information":[{"code":"184","type":"MS-DRG"}],"standard_charges":[{"minimum":8686.78,"maximum":8686.78,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8686.78,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Pleural Effusion With Cc","code_information":[{"code":"187","type":"MS-DRG"}],"standard_charges":[{"minimum":6885.56,"maximum":7451.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6885.56,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7451.42,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Pleural Effusion Without Cc/Mcc","code_information":[{"code":"188","type":"MS-DRG"}],"standard_charges":[{"minimum":6468.56,"maximum":10722.08,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10722.08,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6468.56,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Pulmonary Edema And Respiratory Failure","code_information":[{"code":"189","type":"MS-DRG"}],"standard_charges":[{"minimum":8900.21,"maximum":19543.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13890.06,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9911.13,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19543.29,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14127.76,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8900.21,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Chronic Obstructive Pulmonary Disease With Mcc","code_information":[{"code":"190","type":"MS-DRG"}],"standard_charges":[{"minimum":7763.44,"maximum":15454.71,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8008.77,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15454.71,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7763.44,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Chronic Obstructive Pulmonary Disease With Cc","code_information":[{"code":"191","type":"MS-DRG"}],"standard_charges":[{"minimum":5724.51,"maximum":11700.41,"setting":"inpatient","payers_information":[{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11700.41,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6521.50,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5724.51,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Chronic Obstructive Pulmonary Disease Without Cc/Mcc","code_information":[{"code":"192","type":"MS-DRG"}],"standard_charges":[{"minimum":4522.53,"maximum":8378.24,"setting":"inpatient","payers_information":[{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8378.24,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5728.26,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4522.53,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Simple Pneumonia And Pleurisy With Mcc","code_information":[{"code":"193","type":"MS-DRG"}],"standard_charges":[{"minimum":8430.18,"maximum":21342.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8430.18,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21342.98,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14735.63,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18893.11,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9306.84,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Simple Pneumonia And Pleurisy With Cc","code_information":[{"code":"194","type":"MS-DRG"}],"standard_charges":[{"minimum":3695.49,"maximum":15716.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4711.99,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15716.57,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12128.2,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11959.62,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6294.47,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3695.49,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Simple Pneumonia And Pleurisy Without Cc/Mcc","code_information":[{"code":"195","type":"MS-DRG"}],"standard_charges":[{"minimum":5207.98,"maximum":20848.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20848.05,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5207.98,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Interstitial Lung Disease Without Cc/Mcc","code_information":[{"code":"198","type":"MS-DRG"}],"standard_charges":[{"minimum":4995.09,"maximum":4995.09,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4995.09,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Pneumothorax With Mcc","code_information":[{"code":"199","type":"MS-DRG"}],"standard_charges":[{"minimum":8952.0,"maximum":11598.92,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11598.92,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8952.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Pneumothorax With Cc","code_information":[{"code":"200","type":"MS-DRG"}],"standard_charges":[{"minimum":7563.77,"maximum":7563.77,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7563.77,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Bronchitis And Asthma Without Cc/Mcc","code_information":[{"code":"203","type":"MS-DRG"}],"standard_charges":[{"minimum":3540.10,"maximum":9862.77,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9420.33,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9652.03,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3841.85,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9862.77,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6549.91,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3540.10,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Respiratory Signs And Symptoms","code_information":[{"code":"204","type":"MS-DRG"}],"standard_charges":[{"minimum":6520.66,"maximum":6520.66,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6520.66,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Respiratory System Diagnoses With Mcc","code_information":[{"code":"205","type":"MS-DRG"}],"standard_charges":[{"minimum":4443.32,"maximum":7469.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7469.72,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4443.32,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Respiratory System Diagnoses Without Mcc","code_information":[{"code":"206","type":"MS-DRG"}],"standard_charges":[{"minimum":7097.56,"maximum":7097.56,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7097.56,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Respiratory System Diagnosis With Ventilator Support >96 Hours","code_information":[{"code":"207","type":"MS-DRG"}],"standard_charges":[{"minimum":50959.54,"maximum":51444.88,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":50959.54,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":51444.88,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Respiratory System Diagnosis With Ventilator Support <=96 Hours","code_information":[{"code":"208","type":"MS-DRG"}],"standard_charges":[{"minimum":13642.6,"maximum":32784.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18539.89,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":32784.61,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18806.45,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13642.6,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26866.1,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Cardiothoracic Procedures Without Mcc","code_information":[{"code":"229","type":"MS-DRG"}],"standard_charges":[{"minimum":24045.51,"maximum":24045.51,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24045.51,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc","code_information":[{"code":"239","type":"MS-DRG"}],"standard_charges":[{"minimum":34432.45,"maximum":58616.48,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":58616.48,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":34432.45,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc","code_information":[{"code":"240","type":"MS-DRG"}],"standard_charges":[{"minimum":19172.57,"maximum":42397.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20737.95,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":42397.57,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19172.57,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Permanent Cardiac Pacemaker Implant With Mcc","code_information":[{"code":"242","type":"MS-DRG"}],"standard_charges":[{"minimum":45683.5,"maximum":45683.5,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":45683.5,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Permanent Cardiac Pacemaker Implant With Cc","code_information":[{"code":"243","type":"MS-DRG"}],"standard_charges":[{"minimum":15722.3,"maximum":41025.39,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":41025.39,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15722.3,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Permanent Cardiac Pacemaker Implant Without Cc/Mcc","code_information":[{"code":"244","type":"MS-DRG"}],"standard_charges":[{"minimum":13459.85,"maximum":14942.44,"setting":"inpatient","payers_information":[{"payer_name":"Georgia Assurance","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14942.44,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13459.85,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","code_information":[{"code":"246","type":"MS-DRG"}],"standard_charges":[{"minimum":20637.77,"maximum":66885.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":66885.53,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20637.77,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc","code_information":[{"code":"247","type":"MS-DRG"}],"standard_charges":[{"minimum":2275.26,"maximum":56387.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":56387.0,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14938.15,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29602.15,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14430.33,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13869.58,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2275.26,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc","code_information":[{"code":"250","type":"MS-DRG"}],"standard_charges":[{"minimum":17959.44,"maximum":17959.44,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17959.44,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc","code_information":[{"code":"251","type":"MS-DRG"}],"standard_charges":[{"minimum":12435.71,"maximum":14300.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12435.71,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14300.22,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Vascular Procedures With Cc","code_information":[{"code":"253","type":"MS-DRG"}],"standard_charges":[{"minimum":17673.04,"maximum":17673.04,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17673.04,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Vascular Procedures Without Cc/Mcc","code_information":[{"code":"254","type":"MS-DRG"}],"standard_charges":[{"minimum":12610.78,"maximum":24995.41,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24995.41,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12610.78,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc","code_information":[{"code":"255","type":"MS-DRG"}],"standard_charges":[{"minimum":19492.51,"maximum":19492.51,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19492.51,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders With Cc","code_information":[{"code":"256","type":"MS-DRG"}],"standard_charges":[{"minimum":11883.98,"maximum":24125.23,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24125.23,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11883.98,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc","code_information":[{"code":"262","type":"MS-DRG"}],"standard_charges":[{"minimum":11272.66,"maximum":11272.66,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11272.66,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Circulatory System O.R. Procedures","code_information":[{"code":"264","type":"MS-DRG"}],"standard_charges":[{"minimum":23502.58,"maximum":25021.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25021.52,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23502.58,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc","code_information":[{"code":"269","type":"MS-DRG"}],"standard_charges":[{"minimum":5859.13,"maximum":5859.13,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5859.13,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Major Cardiovascular Procedures With Mcc","code_information":[{"code":"270","type":"MS-DRG"}],"standard_charges":[{"minimum":36799.70,"maximum":36799.70,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":36799.70,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Major Cardiovascular Procedures With Cc","code_information":[{"code":"271","type":"MS-DRG"}],"standard_charges":[{"minimum":10955.46,"maximum":10955.46,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10955.46,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Major Cardiovascular Procedures Without Cc/Mcc","code_information":[{"code":"272","type":"MS-DRG"}],"standard_charges":[{"minimum":36737.98,"maximum":36737.98,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":36737.98,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc","code_information":[{"code":"279","type":"MS-DRG"}],"standard_charges":[{"minimum":23601.97,"maximum":84817.53,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":84817.53,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23601.97,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Acute Myocardial Infarction, Discharged Alive With Mcc","code_information":[{"code":"280","type":"MS-DRG"}],"standard_charges":[{"minimum":11042.03,"maximum":11042.03,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11042.03,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Acute Myocardial Infarction, Discharged Alive With Cc","code_information":[{"code":"281","type":"MS-DRG"}],"standard_charges":[{"minimum":2250.63,"maximum":17425.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16791.72,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9356.74,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17425.81,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12791.30,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6709.14,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2250.63,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc","code_information":[{"code":"282","type":"MS-DRG"}],"standard_charges":[{"minimum":6324.61,"maximum":19331.15,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19331.15,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6985.51,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8624.11,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6324.61,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Acute Myocardial Infarction, Expired With Mcc","code_information":[{"code":"283","type":"MS-DRG"}],"standard_charges":[{"minimum":14179.96,"maximum":14179.96,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14179.96,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Acute Myocardial Infarction, Expired Without Cc/Mcc","code_information":[{"code":"285","type":"MS-DRG"}],"standard_charges":[{"minimum":4979.56,"maximum":4979.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4979.56,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc","code_information":[{"code":"286","type":"MS-DRG"}],"standard_charges":[{"minimum":10681.70,"maximum":30968.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16104.18,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27795.68,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30968.38,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15279.08,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10681.70,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc","code_information":[{"code":"287","type":"MS-DRG"}],"standard_charges":[{"minimum":7732.69,"maximum":15863.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7732.69,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15863.08,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14791.78,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13587.44,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8553.57,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Acute And Subacute Endocarditis With Mcc","code_information":[{"code":"288","type":"MS-DRG"}],"standard_charges":[{"minimum":18975.53,"maximum":18975.53,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18975.53,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Heart Failure And Shock With Mcc","code_information":[{"code":"291","type":"MS-DRG"}],"standard_charges":[{"minimum":8970.36,"maximum":21163.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9917.45,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21163.03,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17319.42,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8970.36,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16534.14,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8998.08,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Heart Failure And Shock With Cc","code_information":[{"code":"292","type":"MS-DRG"}],"standard_charges":[{"minimum":5904.52,"maximum":5904.52,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5904.52,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cardiac Arrest, Unexplained With Mcc","code_information":[{"code":"296","type":"MS-DRG"}],"standard_charges":[{"minimum":12968.66,"maximum":12968.66,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12968.66,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Peripheral Vascular Disorders With Cc","code_information":[{"code":"300","type":"MS-DRG"}],"standard_charges":[{"minimum":8908.51,"maximum":8908.51,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8908.51,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Peripheral Vascular Disorders Without Cc/Mcc","code_information":[{"code":"301","type":"MS-DRG"}],"standard_charges":[{"minimum":5166.97,"maximum":5166.97,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5166.97,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Atherosclerosis With Mcc","code_information":[{"code":"302","type":"MS-DRG"}],"standard_charges":[{"minimum":8022.23,"maximum":8022.23,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8022.23,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hypertension With Mcc","code_information":[{"code":"304","type":"MS-DRG"}],"standard_charges":[{"minimum":7581.71,"maximum":7581.71,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7581.71,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hypertension Without Mcc","code_information":[{"code":"305","type":"MS-DRG"}],"standard_charges":[{"minimum":5011.31,"maximum":5600.88,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5011.31,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5600.88,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cardiac Arrhythmia And Conduction Disorders With Mcc","code_information":[{"code":"308","type":"MS-DRG"}],"standard_charges":[{"minimum":7940.42,"maximum":16408.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9992.15,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14287.19,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16408.99,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7940.42,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cardiac Arrhythmia And Conduction Disorders With Cc","code_information":[{"code":"309","type":"MS-DRG"}],"standard_charges":[{"minimum":1650.0,"maximum":10723.97,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10288.72,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10723.97,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6751.96,"methodology":"other"},{"payer_name":"PHCS","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":1650.0,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc","code_information":[{"code":"310","type":"MS-DRG"}],"standard_charges":[{"minimum":2909.2,"maximum":8844.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4736.53,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2909.2,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6105.77,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8844.16,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5580.4,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Angina Pectoris","code_information":[{"code":"311","type":"MS-DRG"}],"standard_charges":[{"minimum":6285.27,"maximum":6285.27,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6285.27,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Syncope And Collapse","code_information":[{"code":"312","type":"MS-DRG"}],"standard_charges":[{"minimum":2238.0,"maximum":11414.68,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11414.68,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6831.61,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2238.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Circulatory System Diagnoses With Mcc","code_information":[{"code":"314","type":"MS-DRG"}],"standard_charges":[{"minimum":15238.61,"maximum":30437.4,"setting":"inpatient","payers_information":[{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30437.4,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15238.61,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Circulatory System Diagnoses With Cc","code_information":[{"code":"315","type":"MS-DRG"}],"standard_charges":[{"minimum":6893.69,"maximum":8582.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8582.76,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6893.69,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Circulatory System Diagnoses Without Cc/Mcc","code_information":[{"code":"316","type":"MS-DRG"}],"standard_charges":[{"minimum":9618.11,"maximum":9618.11,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9618.11,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal","code_information":[{"code":"321","type":"MS-DRG"}],"standard_charges":[{"minimum":19592.35,"maximum":92928.31,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":92928.31,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21295.34,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19592.35,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc","code_information":[{"code":"322","type":"MS-DRG"}],"standard_charges":[{"minimum":4364.1,"maximum":87217.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14892.01,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":87217.74,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":60549.99,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14313.82,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4364.1,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc","code_information":[{"code":"323","type":"MS-DRG"}],"standard_charges":[{"minimum":31026.76,"maximum":31026.76,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31026.76,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc","code_information":[{"code":"324","type":"MS-DRG"}],"standard_charges":[{"minimum":21246.93,"maximum":21246.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21246.93,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Stomach, Esophageal And Duodenal Procedures With Mcc","code_information":[{"code":"326","type":"MS-DRG"}],"standard_charges":[{"minimum":11620.08,"maximum":11620.08,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11620.08,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Stomach, Esophageal And Duodenal Procedures With Cc","code_information":[{"code":"327","type":"MS-DRG"}],"standard_charges":[{"minimum":15239.47,"maximum":42115.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17768.0,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":42115.68,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15239.47,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc","code_information":[{"code":"328","type":"MS-DRG"}],"standard_charges":[{"minimum":23341.49,"maximum":23341.49,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23341.49,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Small And Large Bowel Procedures With Mcc","code_information":[{"code":"329","type":"MS-DRG"}],"standard_charges":[{"minimum":31776.49,"maximum":84187.41,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":34072.68,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":84187.41,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31776.49,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Small And Large Bowel Procedures With Cc","code_information":[{"code":"330","type":"MS-DRG"}],"standard_charges":[{"minimum":16372.72,"maximum":124889.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":124889.13,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16973.62,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23343.03,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":104451.56,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":34499.27,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16372.72,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Small And Large Bowel Procedures Without Cc/Mcc","code_information":[{"code":"331","type":"MS-DRG"}],"standard_charges":[{"minimum":11486.04,"maximum":53747.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":53747.81,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11486.04,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23222.95,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25508.67,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24844.24,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12175.04,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16122.29,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Peritoneal Adhesiolysis With Cc","code_information":[{"code":"336","type":"MS-DRG"}],"standard_charges":[{"minimum":14125.38,"maximum":36277.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14125.38,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":36277.24,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16026.18,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Peritoneal Adhesiolysis Without Cc/Mcc","code_information":[{"code":"337","type":"MS-DRG"}],"standard_charges":[{"minimum":22006.16,"maximum":22130.52,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22130.52,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22006.16,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"340","type":"MS-DRG"}],"standard_charges":[{"minimum":2330.19,"maximum":19182.52,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19182.52,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8758.03,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2330.19,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Minor Small And Large Bowel Procedures With Mcc","code_information":[{"code":"344","type":"MS-DRG"}],"standard_charges":[{"minimum":18923.44,"maximum":18923.44,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18923.44,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hernia Procedures Except Inguinal And Femoral With Cc","code_information":[{"code":"354","type":"MS-DRG"}],"standard_charges":[{"minimum":10259.38,"maximum":24767.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23591.13,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24767.66,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10259.38,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc","code_information":[{"code":"355","type":"MS-DRG"}],"standard_charges":[{"minimum":4869.12,"maximum":15284.1,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15284.1,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9865.74,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4869.12,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Digestive System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"358","type":"MS-DRG"}],"standard_charges":[{"minimum":15257.64,"maximum":15257.64,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15257.64,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Esophageal Disorders With Mcc","code_information":[{"code":"368","type":"MS-DRG"}],"standard_charges":[{"minimum":7154.24,"maximum":7154.24,"setting":"inpatient","payers_information":[{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7154.24,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Esophageal Disorders With Cc","code_information":[{"code":"369","type":"MS-DRG"}],"standard_charges":[{"minimum":7079.07,"maximum":7079.07,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7079.07,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections With Mcc","code_information":[{"code":"371","type":"MS-DRG"}],"standard_charges":[{"minimum":11100.9,"maximum":11100.9,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11100.9,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections With Cc","code_information":[{"code":"372","type":"MS-DRG"}],"standard_charges":[{"minimum":8102.24,"maximum":11097.71,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8102.24,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11097.71,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8934.1,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc","code_information":[{"code":"373","type":"MS-DRG"}],"standard_charges":[{"minimum":5562.13,"maximum":5562.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5562.13,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Digestive Malignancy With Mcc","code_information":[{"code":"374","type":"MS-DRG"}],"standard_charges":[{"minimum":14675.30,"maximum":14675.30,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14675.30,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Digestive Malignancy With Cc","code_information":[{"code":"375","type":"MS-DRG"}],"standard_charges":[{"minimum":8298.03,"maximum":18762.52,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18762.52,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8298.03,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12759.77,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Gastrointestinal Hemorrhage With Mcc","code_information":[{"code":"377","type":"MS-DRG"}],"standard_charges":[{"minimum":11221.07,"maximum":27970.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11221.07,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27970.05,"methodology":"other"},{"payer_name":"Georgia Assurance","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12904.19,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13639.34,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Gastrointestinal Hemorrhage With Cc","code_information":[{"code":"378","type":"MS-DRG"}],"standard_charges":[{"minimum":4476.0,"maximum":16397.01,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7647.35,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15695.19,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16397.01,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7216.58,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6654.46,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4476.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Gastrointestinal Hemorrhage Without Cc/Mcc","code_information":[{"code":"379","type":"MS-DRG"}],"standard_charges":[{"minimum":5074.40,"maximum":15889.85,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9262.67,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15889.85,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5074.40,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Complicated Peptic Ulcer With Mcc","code_information":[{"code":"380","type":"MS-DRG"}],"standard_charges":[{"minimum":14488.4,"maximum":14488.4,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14488.4,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Complicated Peptic Ulcer With Cc","code_information":[{"code":"381","type":"MS-DRG"}],"standard_charges":[{"minimum":6817.76,"maximum":6817.76,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6817.76,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inflammatory Bowel Disease With Cc","code_information":[{"code":"386","type":"MS-DRG"}],"standard_charges":[{"minimum":14975.82,"maximum":14975.82,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14975.82,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Gastrointestinal Obstruction With Cc","code_information":[{"code":"389","type":"MS-DRG"}],"standard_charges":[{"minimum":5211.57,"maximum":14466.92,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14466.92,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14352.11,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5211.57,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Gastrointestinal Obstruction Without Cc/Mcc","code_information":[{"code":"390","type":"MS-DRG"}],"standard_charges":[{"minimum":2238.0,"maximum":6476.70,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5257.97,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6476.70,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3432.24,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4401.18,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3774.6,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2238.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc","code_information":[{"code":"391","type":"MS-DRG"}],"standard_charges":[{"minimum":10127.01,"maximum":18694.39,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15146.49,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18694.39,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10127.01,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc","code_information":[{"code":"392","type":"MS-DRG"}],"standard_charges":[{"minimum":4476.0,"maximum":10923.59,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9974.85,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10923.59,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10715.85,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4825.0,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9703.34,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6133.98,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4476.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Digestive System Diagnoses With Mcc","code_information":[{"code":"393","type":"MS-DRG"}],"standard_charges":[{"minimum":10770.27,"maximum":10770.27,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10770.27,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Digestive System Diagnoses With Cc","code_information":[{"code":"394","type":"MS-DRG"}],"standard_charges":[{"minimum":7390.42,"maximum":7390.42,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7390.42,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Digestive System Diagnoses Without Cc/Mcc","code_information":[{"code":"395","type":"MS-DRG"}],"standard_charges":[{"minimum":6247.2,"maximum":6247.2,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6247.2,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Appendix Procedures With Mcc","code_information":[{"code":"397","type":"MS-DRG"}],"standard_charges":[{"minimum":17261.64,"maximum":32812.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":32812.5,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17922.43,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17261.64,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Appendix Procedures With Cc","code_information":[{"code":"398","type":"MS-DRG"}],"standard_charges":[{"minimum":17236.56,"maximum":41398.69,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17236.56,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":41398.69,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cholecystectomy With C.D.E. With Mcc","code_information":[{"code":"411","type":"MS-DRG"}],"standard_charges":[{"minimum":8647.61,"maximum":45962.48,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":45962.48,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23861.06,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8647.61,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc","code_information":[{"code":"414","type":"MS-DRG"}],"standard_charges":[{"minimum":25638.06,"maximum":25638.06,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25638.06,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc","code_information":[{"code":"416","type":"MS-DRG"}],"standard_charges":[{"minimum":11415.84,"maximum":11415.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11415.84,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. With Mcc","code_information":[{"code":"417","type":"MS-DRG"}],"standard_charges":[{"minimum":17097.58,"maximum":32760.78,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17097.58,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":32760.78,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17236.58,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. With Cc","code_information":[{"code":"418","type":"MS-DRG"}],"standard_charges":[{"minimum":9800.98,"maximum":38158.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":38158.67,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9800.98,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11470.10,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc","code_information":[{"code":"419","type":"MS-DRG"}],"standard_charges":[{"minimum":17343.53,"maximum":38805.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":38805.94,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17343.53,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cirrhosis And Alcoholic Hepatitis With Mcc","code_information":[{"code":"432","type":"MS-DRG"}],"standard_charges":[{"minimum":52463.87,"maximum":52463.87,"setting":"inpatient","payers_information":[{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":52463.87,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cirrhosis And Alcoholic Hepatitis With Cc","code_information":[{"code":"433","type":"MS-DRG"}],"standard_charges":[{"minimum":7465.0,"maximum":14181.58,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14181.58,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7465.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas With Mcc","code_information":[{"code":"435","type":"MS-DRG"}],"standard_charges":[{"minimum":18451.2,"maximum":18451.2,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18451.2,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas With Cc","code_information":[{"code":"436","type":"MS-DRG"}],"standard_charges":[{"minimum":7109.6,"maximum":10946.61,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10946.61,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7109.6,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Disorders Of Pancreas Except Malignancy With Cc","code_information":[{"code":"439","type":"MS-DRG"}],"standard_charges":[{"minimum":4196.46,"maximum":12317.63,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12317.63,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4196.46,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6491.59,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10051.16,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Disorders Of Pancreas Except Malignancy Without Cc/Mcc","code_information":[{"code":"440","type":"MS-DRG"}],"standard_charges":[{"minimum":4779.93,"maximum":8039.59,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4779.93,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8039.59,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6010.52,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc","code_information":[{"code":"441","type":"MS-DRG"}],"standard_charges":[{"minimum":11777.75,"maximum":13380.06,"setting":"inpatient","payers_information":[{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11777.75,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13380.06,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc","code_information":[{"code":"442","type":"MS-DRG"}],"standard_charges":[{"minimum":4413.74,"maximum":15805.51,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13856.77,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15805.51,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4413.74,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6669.59,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc","code_information":[{"code":"443","type":"MS-DRG"}],"standard_charges":[{"minimum":4601.47,"maximum":4601.47,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4601.47,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Disorders Of The Biliary Tract With Cc","code_information":[{"code":"445","type":"MS-DRG"}],"standard_charges":[{"minimum":8366.22,"maximum":8366.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8366.22,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"464","type":"MS-DRG"}],"standard_charges":[{"minimum":15231.43,"maximum":15231.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15231.43,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"465","type":"MS-DRG"}],"standard_charges":[{"minimum":15071.77,"maximum":15071.77,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15071.77,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Revision Of Hip Or Knee Replacement With Cc","code_information":[{"code":"467","type":"MS-DRG"}],"standard_charges":[{"minimum":21404.74,"maximum":21404.74,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21404.74,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Revision Of Hip Or Knee Replacement Without Cc/Mcc","code_information":[{"code":"468","type":"MS-DRG"}],"standard_charges":[{"minimum":113287.21,"maximum":113287.21,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":113287.21,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl","code_information":[{"code":"469","type":"MS-DRG"}],"standard_charges":[{"minimum":23311.63,"maximum":23311.63,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23311.63,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc","code_information":[{"code":"470","type":"MS-DRG"}],"standard_charges":[{"minimum":13920.23,"maximum":27547.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18288.02,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14669.87,"methodology":"other"},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14613.16,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27547.11,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13920.93,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13920.23,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc","code_information":[{"code":"474","type":"MS-DRG"}],"standard_charges":[{"minimum":29670.71,"maximum":31587.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31587.43,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29670.71,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc","code_information":[{"code":"475","type":"MS-DRG"}],"standard_charges":[{"minimum":15529.19,"maximum":15529.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15529.19,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hip And Femur Procedures Except Major Joint With Mcc","code_information":[{"code":"480","type":"MS-DRG"}],"standard_charges":[{"minimum":20629.41,"maximum":20629.41,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20629.41,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hip And Femur Procedures Except Major Joint With Cc","code_information":[{"code":"481","type":"MS-DRG"}],"standard_charges":[{"minimum":14518.86,"maximum":29224.65,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16114.32,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29224.65,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14518.86,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hip And Femur Procedures Except Major Joint Without Cc/Mcc","code_information":[{"code":"482","type":"MS-DRG"}],"standard_charges":[{"minimum":11815.09,"maximum":31356.69,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31356.69,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12126.94,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11815.09,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Joint Or Limb Reattachment Procedures Of Upper Extremities","code_information":[{"code":"483","type":"MS-DRG"}],"standard_charges":[{"minimum":17754.69,"maximum":17754.69,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17754.69,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection With Cc","code_information":[{"code":"486","type":"MS-DRG"}],"standard_charges":[{"minimum":14166.22,"maximum":14166.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14166.22,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc","code_information":[{"code":"489","type":"MS-DRG"}],"standard_charges":[{"minimum":17889.78,"maximum":17889.78,"setting":"inpatient","payers_information":[{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17889.78,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc","code_information":[{"code":"493","type":"MS-DRG"}],"standard_charges":[{"minimum":16264.65,"maximum":34918.32,"setting":"inpatient","payers_information":[{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":34918.32,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16264.65,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc","code_information":[{"code":"494","type":"MS-DRG"}],"standard_charges":[{"minimum":14047.77,"maximum":14047.77,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14047.77,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Foot Procedures With Cc","code_information":[{"code":"504","type":"MS-DRG"}],"standard_charges":[{"minimum":22851.83,"maximum":22851.83,"setting":"inpatient","payers_information":[{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22851.83,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Foot Procedures Without Cc/Mcc","code_information":[{"code":"505","type":"MS-DRG"}],"standard_charges":[{"minimum":13246.13,"maximum":13246.13,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13246.13,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc","code_information":[{"code":"512","type":"MS-DRG"}],"standard_charges":[{"minimum":12545.16,"maximum":12545.16,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12545.16,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc","code_information":[{"code":"516","type":"MS-DRG"}],"standard_charges":[{"minimum":15361.46,"maximum":15361.46,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15361.46,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc","code_information":[{"code":"521","type":"MS-DRG"}],"standard_charges":[{"minimum":18446.18,"maximum":18446.18,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18446.18,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc","code_information":[{"code":"522","type":"MS-DRG"}],"standard_charges":[{"minimum":14865.16,"maximum":30709.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15171.09,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30206.36,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30709.28,"methodology":"other"},{"payer_name":"Georgia Assurance","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14865.16,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15117.62,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Fractures Of Hip And Pelvis With Mcc","code_information":[{"code":"535","type":"MS-DRG"}],"standard_charges":[{"minimum":9142.37,"maximum":9142.37,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9142.37,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Fractures Of Hip And Pelvis Without Mcc","code_information":[{"code":"536","type":"MS-DRG"}],"standard_charges":[{"minimum":5602.48,"maximum":5782.04,"setting":"inpatient","payers_information":[{"payer_name":"Georgia Assurance","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5602.48,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5782.04,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc","code_information":[{"code":"543","type":"MS-DRG"}],"standard_charges":[{"minimum":9312.59,"maximum":9312.59,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9312.59,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc","code_information":[{"code":"544","type":"MS-DRG"}],"standard_charges":[{"minimum":8221.83,"maximum":8221.83,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8221.83,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Connective Tissue Disorders With Cc","code_information":[{"code":"546","type":"MS-DRG"}],"standard_charges":[{"minimum":8673.86,"maximum":8673.86,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8673.86,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Medical Back Problems With Mcc","code_information":[{"code":"551","type":"MS-DRG"}],"standard_charges":[{"minimum":13395.27,"maximum":13395.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13395.27,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Medical Back Problems Without Mcc","code_information":[{"code":"552","type":"MS-DRG"}],"standard_charges":[{"minimum":6890.68,"maximum":6890.68,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6890.68,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Tendonitis, Myositis And Bursitis Without Mcc","code_information":[{"code":"558","type":"MS-DRG"}],"standard_charges":[{"minimum":6808.21,"maximum":9145.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9145.5,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6808.21,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue With Cc","code_information":[{"code":"560","type":"MS-DRG"}],"standard_charges":[{"minimum":7322.43,"maximum":7707.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7707.7,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7322.43,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc","code_information":[{"code":"561","type":"MS-DRG"}],"standard_charges":[{"minimum":1743.98,"maximum":1743.98,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1743.98,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc","code_information":[{"code":"563","type":"MS-DRG"}],"standard_charges":[{"minimum":7560.1,"maximum":7560.1,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7560.1,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses With Cc","code_information":[{"code":"565","type":"MS-DRG"}],"standard_charges":[{"minimum":7071.66,"maximum":7071.66,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7071.66,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc","code_information":[{"code":"566","type":"MS-DRG"}],"standard_charges":[{"minimum":4306.52,"maximum":4306.52,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4306.52,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Skin Debridement With Cc","code_information":[{"code":"571","type":"MS-DRG"}],"standard_charges":[{"minimum":11506.04,"maximum":23859.52,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23859.52,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11506.04,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Skin Debridement Without Cc/Mcc","code_information":[{"code":"572","type":"MS-DRG"}],"standard_charges":[{"minimum":7896.11,"maximum":7896.11,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7896.11,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis With Cc","code_information":[{"code":"574","type":"MS-DRG"}],"standard_charges":[{"minimum":64479.37,"maximum":64479.37,"setting":"inpatient","payers_information":[{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":64479.37,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc","code_information":[{"code":"579","type":"MS-DRG"}],"standard_charges":[{"minimum":25013.37,"maximum":25013.37,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25013.37,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures With Cc","code_information":[{"code":"580","type":"MS-DRG"}],"standard_charges":[{"minimum":12436.0,"maximum":12436.0,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12436.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc","code_information":[{"code":"581","type":"MS-DRG"}],"standard_charges":[{"minimum":6625.5,"maximum":6625.5,"setting":"inpatient","payers_information":[{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6625.5,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Mastectomy For Malignancy With Cc/Mcc","code_information":[{"code":"582","type":"MS-DRG"}],"standard_charges":[{"minimum":13168.34,"maximum":13168.34,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13168.34,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Skin Ulcers With Cc","code_information":[{"code":"593","type":"MS-DRG"}],"standard_charges":[{"minimum":8033.92,"maximum":10331.16,"setting":"inpatient","payers_information":[{"payer_name":"Georgia Assurance","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10331.16,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8033.92,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Skin Ulcers Without Cc/Mcc","code_information":[{"code":"594","type":"MS-DRG"}],"standard_charges":[{"minimum":7473.48,"maximum":7473.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7473.48,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Malignant Breast Disorders With Mcc","code_information":[{"code":"597","type":"MS-DRG"}],"standard_charges":[{"minimum":13551.84,"maximum":13551.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13551.84,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Non-Malignant Breast Disorders Without Cc/Mcc","code_information":[{"code":"601","type":"MS-DRG"}],"standard_charges":[{"minimum":3944.71,"maximum":3944.71,"setting":"inpatient","payers_information":[{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3944.71,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cellulitis With Mcc","code_information":[{"code":"602","type":"MS-DRG"}],"standard_charges":[{"minimum":10538.17,"maximum":18878.94,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18878.94,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10538.17,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cellulitis Without Mcc","code_information":[{"code":"603","type":"MS-DRG"}],"standard_charges":[{"minimum":5345.3,"maximum":12607.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7371.52,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9946.81,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12607.57,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6279.86,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5345.3,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc","code_information":[{"code":"605","type":"MS-DRG"}],"standard_charges":[{"minimum":11123.15,"maximum":11123.15,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11123.15,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc","code_information":[{"code":"617","type":"MS-DRG"}],"standard_charges":[{"minimum":13570.93,"maximum":28263.82,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14298.75,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28263.82,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13570.93,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13730.12,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc","code_information":[{"code":"623","type":"MS-DRG"}],"standard_charges":[{"minimum":12831.55,"maximum":28701.95,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15080.19,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28701.95,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12831.55,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Diabetes With Mcc","code_information":[{"code":"637","type":"MS-DRG"}],"standard_charges":[{"minimum":8766.74,"maximum":18288.52,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14618.75,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17042.67,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8766.74,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18288.52,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9993.66,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Diabetes With Cc","code_information":[{"code":"638","type":"MS-DRG"}],"standard_charges":[{"minimum":5117.67,"maximum":17472.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17472.44,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7548.46,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10904.43,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5117.67,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11387.69,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6165.91,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Diabetes Without Cc/Mcc","code_information":[{"code":"639","type":"MS-DRG"}],"standard_charges":[{"minimum":2451.97,"maximum":8521.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6292.96,"methodology":"other"},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4748.89,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8521.72,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4402.41,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7446.88,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4878.33,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3610.44,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2451.97,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc","code_information":[{"code":"640","type":"MS-DRG"}],"standard_charges":[{"minimum":9185.17,"maximum":9185.17,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9185.17,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc","code_information":[{"code":"641","type":"MS-DRG"}],"standard_charges":[{"minimum":5222.43,"maximum":10545.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6241.5,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5222.43,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10545.04,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5726.06,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Endocrine Disorders With Mcc","code_information":[{"code":"643","type":"MS-DRG"}],"standard_charges":[{"minimum":7603.01,"maximum":7603.01,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7603.01,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Kidney And Ureter Procedures For Neoplasm With Cc","code_information":[{"code":"657","type":"MS-DRG"}],"standard_charges":[{"minimum":14330.07,"maximum":14330.07,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14330.07,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm With Cc","code_information":[{"code":"660","type":"MS-DRG"}],"standard_charges":[{"minimum":9667.29,"maximum":29431.95,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29431.95,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9667.29,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc","code_information":[{"code":"661","type":"MS-DRG"}],"standard_charges":[{"minimum":7999.98,"maximum":19810.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9113.24,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19810.99,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7999.98,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8066.13,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Minor Bladder Procedures With Mcc","code_information":[{"code":"662","type":"MS-DRG"}],"standard_charges":[{"minimum":21994.39,"maximum":21994.39,"setting":"inpatient","payers_information":[{"payer_name":"Georgia Assurance","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21994.39,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Kidney And Urinary Tract Procedures With Mcc","code_information":[{"code":"673","type":"MS-DRG"}],"standard_charges":[{"minimum":24216.7,"maximum":24216.7,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24216.7,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Renal Failure With Mcc","code_information":[{"code":"682","type":"MS-DRG"}],"standard_charges":[{"minimum":10110.46,"maximum":14893.69,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14893.69,"methodology":"other"},{"payer_name":"Georgia Assurance","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12046.07,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10110.46,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Renal Failure With Cc","code_information":[{"code":"683","type":"MS-DRG"}],"standard_charges":[{"minimum":6181.79,"maximum":34325.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":34325.24,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6438.17,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14992.13,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6181.79,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Renal Failure Without Cc/Mcc","code_information":[{"code":"684","type":"MS-DRG"}],"standard_charges":[{"minimum":4641.51,"maximum":33089.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":33089.26,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4641.51,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Kidney And Urinary Tract Infections With Mcc","code_information":[{"code":"689","type":"MS-DRG"}],"standard_charges":[{"minimum":1456.03,"maximum":16221.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1456.03,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16221.26,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8278.97,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Kidney And Urinary Tract Infections Without Mcc","code_information":[{"code":"690","type":"MS-DRG"}],"standard_charges":[{"minimum":2987.08,"maximum":12162.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5935.07,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12162.53,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10676.66,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5058.25,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5870.95,"methodology":"other"},{"payer_name":"Georgia Assurance","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3407.58,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6129.56,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2987.08,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Urinary Stones Without Mcc","code_information":[{"code":"694","type":"MS-DRG"}],"standard_charges":[{"minimum":6813.71,"maximum":6813.71,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6813.71,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Kidney And Urinary Tract Diagnoses With Mcc","code_information":[{"code":"698","type":"MS-DRG"}],"standard_charges":[{"minimum":11405.8,"maximum":27482.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27482.55,"methodology":"other"},{"payer_name":"Georgia Assurance","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13580.16,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11405.8,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Kidney And Urinary Tract Diagnoses With Cc","code_information":[{"code":"699","type":"MS-DRG"}],"standard_charges":[{"minimum":7951.61,"maximum":7951.61,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7951.61,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Male Pelvic Procedures Without Cc/Mcc","code_information":[{"code":"708","type":"MS-DRG"}],"standard_charges":[{"minimum":2250.63,"maximum":19511.51,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19511.51,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2250.63,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Transurethral Prostatectomy With Cc/Mcc","code_information":[{"code":"713","type":"MS-DRG"}],"standard_charges":[{"minimum":10897.30,"maximum":18268.48,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18268.48,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10897.30,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc","code_information":[{"code":"717","type":"MS-DRG"}],"standard_charges":[{"minimum":1790.4,"maximum":21623.39,"setting":"inpatient","payers_information":[{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21623.39,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1790.4,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Benign Prostatic Hypertrophy Without Mcc","code_information":[{"code":"726","type":"MS-DRG"}],"standard_charges":[{"minimum":5076.69,"maximum":5076.69,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5076.69,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inflammation Of The Male Reproductive System Without Mcc","code_information":[{"code":"728","type":"MS-DRG"}],"standard_charges":[{"minimum":10117.92,"maximum":10117.92,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10117.92,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc","code_information":[{"code":"742","type":"MS-DRG"}],"standard_charges":[{"minimum":3580.8,"maximum":22439.08,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22439.08,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12212.84,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3580.8,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc","code_information":[{"code":"743","type":"MS-DRG"}],"standard_charges":[{"minimum":5745.00,"maximum":15802.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15802.1,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11534.16,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5746.34,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13691.39,"methodology":"other"},{"payer_name":"Humana","plan_name":"Choice Care Leased Network All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7109.96,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6609.94,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5745.00,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Vagina, Cervix And Vulva Procedures With Cc/Mcc","code_information":[{"code":"746","type":"MS-DRG"}],"standard_charges":[{"minimum":12976.11,"maximum":12976.11,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12976.11,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Female Reproductive System Reconstructive Procedures","code_information":[{"code":"748","type":"MS-DRG"}],"standard_charges":[{"minimum":10774.02,"maximum":10774.02,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10774.02,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Female Reproductive System O.R. Procedures With Cc/Mcc","code_information":[{"code":"749","type":"MS-DRG"}],"standard_charges":[{"minimum":96735.8,"maximum":96735.8,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":96735.8,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Malignancy, Female Reproductive System With Cc","code_information":[{"code":"755","type":"MS-DRG"}],"standard_charges":[{"minimum":7971.81,"maximum":7971.81,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7971.81,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Infections, Female Reproductive System Without Cc/Mcc","code_information":[{"code":"759","type":"MS-DRG"}],"standard_charges":[{"minimum":5444.9,"maximum":5444.9,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5444.9,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc","code_information":[{"code":"761","type":"MS-DRG"}],"standard_charges":[{"minimum":5687.71,"maximum":5687.71,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5687.71,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C","code_information":[{"code":"768","type":"MS-DRG"}],"standard_charges":[{"minimum":5151.82,"maximum":17066.54,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10020.27,"methodology":"other"},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5773.89,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17066.54,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5151.82,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6140.18,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8390.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Postpartum And Post Abortion Diagnoses With O.R. Procedures","code_information":[{"code":"769","type":"MS-DRG"}],"standard_charges":[{"minimum":22446.76,"maximum":22446.76,"setting":"inpatient","payers_information":[{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22446.76,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Abortion With D&C, Aspiration Curettage Or Hysterotomy","code_information":[{"code":"770","type":"MS-DRG"}],"standard_charges":[{"minimum":20543.27,"maximum":20543.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20543.27,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Postpartum And Post Abortion Diagnoses Without O.R. Procedures","code_information":[{"code":"776","type":"MS-DRG"}],"standard_charges":[{"minimum":2810.08,"maximum":10073.06,"setting":"inpatient","payers_information":[{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2810.08,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10073.06,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3857.08,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8982.75,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3814.44,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cesarean Section With Sterilization With Mcc","code_information":[{"code":"783","type":"MS-DRG"}],"standard_charges":[{"minimum":7759.97,"maximum":7879.9,"setting":"inpatient","payers_information":[{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7759.97,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7879.9,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cesarean Section With Sterilization With Cc","code_information":[{"code":"784","type":"MS-DRG"}],"standard_charges":[{"minimum":6438.95,"maximum":15487.88,"setting":"inpatient","payers_information":[{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7381.42,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15487.88,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13400.46,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6438.95,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cesarean Section With Sterilization Without Cc/Mcc","code_information":[{"code":"785","type":"MS-DRG"}],"standard_charges":[{"minimum":6298.63,"maximum":25973.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25973.94,"methodology":"other"},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6508.48,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12423.64,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6298.63,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6366.1,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6714.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cesarean Section Without Sterilization With Mcc","code_information":[{"code":"786","type":"MS-DRG"}],"standard_charges":[{"minimum":6491.56,"maximum":27442.37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27442.37,"methodology":"other"},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6491.56,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24114.12,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7729.94,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7558.22,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cesarean Section Without Sterilization With Cc","code_information":[{"code":"787","type":"MS-DRG"}],"standard_charges":[{"minimum":7502.44,"maximum":16581.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9787.49,"methodology":"other"},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7747.47,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15731.84,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16581.06,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7502.44,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13612.61,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7628.72,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cesarean Section Without Sterilization Without Cc/Mcc","code_information":[{"code":"788","type":"MS-DRG"}],"standard_charges":[{"minimum":6260.58,"maximum":20489.62,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20489.62,"methodology":"other"},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6508.48,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12279.86,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14326.3,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6298.63,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12143.22,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6420.49,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6260.58,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Neonates, Died Or Transferred To Another Acute Care Facility","code_information":[{"code":"789","type":"MS-DRG"}],"standard_charges":[{"minimum":1894.86,"maximum":1950.21,"setting":"inpatient","payers_information":[{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1950.21,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1894.86,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Extreme Immaturity Or Respiratory Distress Syndrome, Neonate","code_information":[{"code":"790","type":"MS-DRG"}],"standard_charges":[{"minimum":10913.98,"maximum":10913.98,"setting":"inpatient","payers_information":[{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10913.98,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Prematurity With Major Problems","code_information":[{"code":"791","type":"MS-DRG"}],"standard_charges":[{"minimum":4132.88,"maximum":4132.88,"setting":"inpatient","payers_information":[{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4132.88,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Prematurity Without Major Problems","code_information":[{"code":"792","type":"MS-DRG"}],"standard_charges":[{"minimum":2042.25,"maximum":33176.84,"setting":"inpatient","payers_information":[{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3666.43,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":33176.84,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7246.8,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4595.77,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2042.25,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Full Term Neonate With Major Problems","code_information":[{"code":"793","type":"MS-DRG"}],"standard_charges":[{"minimum":2766.2,"maximum":4719.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4256.0,"methodology":"other"},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4634.76,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2766.2,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3954.4,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4719.74,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3212.02,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Neonate With Other Significant Problems","code_information":[{"code":"794","type":"MS-DRG"}],"standard_charges":[{"minimum":1247.38,"maximum":5577.10,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1930.27,"methodology":"other"},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2348.98,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1247.38,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2438.68,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5577.10,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2172.66,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1269.58,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Normal Newborn","code_information":[{"code":"795","type":"MS-DRG"}],"standard_charges":[{"minimum":1526.21,"maximum":3004.01,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1798.72,"methodology":"other"},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1967.91,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1695.29,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3004.01,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1709.63,"methodology":"other"},{"payer_name":"PHCS","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":1639.66,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1526.21,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc","code_information":[{"code":"798","type":"MS-DRG"}],"standard_charges":[{"minimum":6932.16,"maximum":6932.16,"setting":"inpatient","payers_information":[{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6932.16,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Vaginal Delivery Without Sterilization Or D&C With Mcc","code_information":[{"code":"805","type":"MS-DRG"}],"standard_charges":[{"minimum":5316.07,"maximum":14702.48,"setting":"inpatient","payers_information":[{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5316.07,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14702.48,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14260.68,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12928.75,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Vaginal Delivery Without Sterilization Or D&C With Cc","code_information":[{"code":"806","type":"MS-DRG"}],"standard_charges":[{"minimum":5230.45,"maximum":10262.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6780.0,"methodology":"other"},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6342.99,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8563.9,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10262.66,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6139.44,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8357.33,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5801.17,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5230.45,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc","code_information":[{"code":"807","type":"MS-DRG"}],"standard_charges":[{"minimum":3390.0,"maximum":8624.78,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5934.18,"methodology":"other"},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5773.89,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8399.46,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8410.78,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5151.82,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8624.78,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5435.84,"methodology":"other"},{"payer_name":"PHCS","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":4884.51,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3390.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"809","type":"MS-DRG"}],"standard_charges":[{"minimum":12950.72,"maximum":12950.72,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12950.72,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Red Blood Cell Disorders With Mcc","code_information":[{"code":"811","type":"MS-DRG"}],"standard_charges":[{"minimum":3588.38,"maximum":19654.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9794.51,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15075.09,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19654.2,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10625.06,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3588.38,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Red Blood Cell Disorders Without Mcc","code_information":[{"code":"812","type":"MS-DRG"}],"standard_charges":[{"minimum":3097.44,"maximum":18103.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18103.2,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6437.47,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12246.38,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7018.42,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3097.44,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Coagulation Disorders","code_information":[{"code":"813","type":"MS-DRG"}],"standard_charges":[{"minimum":10886.13,"maximum":12285.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12285.88,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10886.13,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Reticuloendothelial And Immunity Disorders With Mcc","code_information":[{"code":"814","type":"MS-DRG"}],"standard_charges":[{"minimum":16539.55,"maximum":16539.55,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16539.55,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Reticuloendothelial And Immunity Disorders With Cc","code_information":[{"code":"815","type":"MS-DRG"}],"standard_charges":[{"minimum":7154.33,"maximum":8610.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7154.33,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8610.91,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Reticuloendothelial And Immunity Disorders Without Cc/Mcc","code_information":[{"code":"816","type":"MS-DRG"}],"standard_charges":[{"minimum":6681.98,"maximum":6681.98,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6681.98,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C","code_information":[{"code":"828","type":"MS-DRG"}],"standard_charges":[{"minimum":12724.6,"maximum":12724.6,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12724.6,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures With Mcc","code_information":[{"code":"831","type":"MS-DRG"}],"standard_charges":[{"minimum":5056.72,"maximum":5056.72,"setting":"inpatient","payers_information":[{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5056.72,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures With Cc","code_information":[{"code":"832","type":"MS-DRG"}],"standard_charges":[{"minimum":5057.82,"maximum":9353.53,"setting":"inpatient","payers_information":[{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9353.53,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5057.82,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc","code_information":[{"code":"833","type":"MS-DRG"}],"standard_charges":[{"minimum":4541.9,"maximum":14702.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14702.99,"methodology":"other"},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4541.9,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6696.95,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4692.10,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Lymphoma And Non-Acute Leukemia Without Cc/Mcc","code_information":[{"code":"842","type":"MS-DRG"}],"standard_charges":[{"minimum":8069.74,"maximum":8069.74,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8069.74,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc","code_information":[{"code":"843","type":"MS-DRG"}],"standard_charges":[{"minimum":12731.34,"maximum":12731.34,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12731.34,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures With Mcc","code_information":[{"code":"853","type":"MS-DRG"}],"standard_charges":[{"minimum":35530.76,"maximum":64833.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":36841.91,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":64833.66,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":35530.76,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures With Cc","code_information":[{"code":"854","type":"MS-DRG"}],"standard_charges":[{"minimum":14056.27,"maximum":15139.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15139.88,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14056.27,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc","code_information":[{"code":"857","type":"MS-DRG"}],"standard_charges":[{"minimum":25699.85,"maximum":25699.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25699.85,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Postoperative And Post-Traumatic Infections With Mcc","code_information":[{"code":"862","type":"MS-DRG"}],"standard_charges":[{"minimum":25239.11,"maximum":25239.11,"setting":"inpatient","payers_information":[{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25239.11,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Postoperative And Post-Traumatic Infections Without Mcc","code_information":[{"code":"863","type":"MS-DRG"}],"standard_charges":[{"minimum":5239.91,"maximum":7659.55,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7659.55,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5239.91,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6726.63,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Fever And Inflammatory Conditions","code_information":[{"code":"864","type":"MS-DRG"}],"standard_charges":[{"minimum":6693.00,"maximum":6693.00,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6693.00,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Viral Illness Without Mcc","code_information":[{"code":"866","type":"MS-DRG"}],"standard_charges":[{"minimum":5399.31,"maximum":9242.84,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9242.84,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5399.31,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses With Mcc","code_information":[{"code":"867","type":"MS-DRG"}],"standard_charges":[{"minimum":16166.73,"maximum":16166.73,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16166.73,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Septicemia Or Severe Sepsis With Mv >96 Hours","code_information":[{"code":"870","type":"MS-DRG"}],"standard_charges":[{"minimum":50975.13,"maximum":109631.81,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":109631.81,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":50975.13,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc","code_information":[{"code":"871","type":"MS-DRG"}],"standard_charges":[{"minimum":10083.63,"maximum":27619.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12129.74,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27480.86,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27619.14,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21977.56,"methodology":"other"},{"payer_name":"Georgia Assurance","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14314.45,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13886.16,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10293.99,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10083.63,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc","code_information":[{"code":"872","type":"MS-DRG"}],"standard_charges":[{"minimum":6617.04,"maximum":7162.37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7162.37,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6617.04,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Acute Adjustment Reaction And Psychosocial Dysfunction","code_information":[{"code":"880","type":"MS-DRG"}],"standard_charges":[{"minimum":7788.57,"maximum":35489.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13072.06,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7788.57,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":35489.43,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Depressive Neuroses","code_information":[{"code":"881","type":"MS-DRG"}],"standard_charges":[{"minimum":3619.1,"maximum":3619.1,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3619.1,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Organic Disturbances And Intellectual Disability","code_information":[{"code":"884","type":"MS-DRG"}],"standard_charges":[{"minimum":12556.74,"maximum":12662.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12592.77,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12556.74,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12662.86,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Psychoses","code_information":[{"code":"885","type":"MS-DRG"}],"standard_charges":[{"minimum":9390.92,"maximum":19989.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13195.36,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15049.96,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11133.31,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19989.68,"methodology":"other"},{"payer_name":"Georgia Assurance","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10762.23,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9390.92,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc","code_information":[{"code":"897","type":"MS-DRG"}],"standard_charges":[{"minimum":4331.2,"maximum":10073.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7109.6,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10073.06,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6680.63,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4331.2,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Wound Debridements For Injuries With Cc","code_information":[{"code":"902","type":"MS-DRG"}],"standard_charges":[{"minimum":13481.92,"maximum":13481.92,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13481.92,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other O.R. Procedures For Injuries With Mcc","code_information":[{"code":"907","type":"MS-DRG"}],"standard_charges":[{"minimum":7605.7,"maximum":28660.14,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28660.14,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7605.7,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other O.R. Procedures For Injuries With Cc","code_information":[{"code":"908","type":"MS-DRG"}],"standard_charges":[{"minimum":29148.92,"maximum":29148.92,"setting":"inpatient","payers_information":[{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29148.92,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other O.R. Procedures For Injuries Without Cc/Mcc","code_information":[{"code":"909","type":"MS-DRG"}],"standard_charges":[{"minimum":48141.5,"maximum":48141.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":48141.5,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Traumatic Injury Without Mcc","code_information":[{"code":"914","type":"MS-DRG"}],"standard_charges":[{"minimum":6491.36,"maximum":6491.36,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6491.36,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Allergic Reactions With Mcc","code_information":[{"code":"915","type":"MS-DRG"}],"standard_charges":[{"minimum":4340.81,"maximum":17075.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17075.52,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12984.06,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4340.81,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Allergic Reactions Without Mcc","code_information":[{"code":"916","type":"MS-DRG"}],"standard_charges":[{"minimum":5617.99,"maximum":5617.99,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5617.99,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Poisoning And Toxic Effects Of Drugs With Mcc","code_information":[{"code":"917","type":"MS-DRG"}],"standard_charges":[{"minimum":2387.67,"maximum":78407.79,"setting":"inpatient","payers_information":[{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8509.93,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":78407.79,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7653.04,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23214.1,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10917.89,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2387.67,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Poisoning And Toxic Effects Of Drugs Without Mcc","code_information":[{"code":"918","type":"MS-DRG"}],"standard_charges":[{"minimum":4178.4,"maximum":9552.11,"setting":"inpatient","payers_information":[{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4178.4,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9552.11,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Complications Of Treatment With Mcc","code_information":[{"code":"919","type":"MS-DRG"}],"standard_charges":[{"minimum":14108.68,"maximum":14902.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14902.19,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14108.68,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Complications Of Treatment With Cc","code_information":[{"code":"920","type":"MS-DRG"}],"standard_charges":[{"minimum":1763.2,"maximum":7546.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7546.02,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6486.68,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1763.2,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Complications Of Treatment Without Cc/Mcc","code_information":[{"code":"921","type":"MS-DRG"}],"standard_charges":[{"minimum":9805.13,"maximum":9911.74,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9805.13,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9911.74,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Signs And Symptoms With Mcc","code_information":[{"code":"947","type":"MS-DRG"}],"standard_charges":[{"minimum":9590.99,"maximum":9590.99,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9590.99,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Signs And Symptoms Without Mcc","code_information":[{"code":"948","type":"MS-DRG"}],"standard_charges":[{"minimum":4122.41,"maximum":10898.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5285.89,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9482.37,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10898.64,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5970.15,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4122.41,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Multiple Significant Trauma With Mcc","code_information":[{"code":"963","type":"MS-DRG"}],"standard_charges":[{"minimum":18609.02,"maximum":18609.02,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18609.02,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","code_information":[{"code":"981","type":"MS-DRG"}],"standard_charges":[{"minimum":33957.42,"maximum":37270.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":37270.52,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":33957.42,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","code_information":[{"code":"982","type":"MS-DRG"}],"standard_charges":[{"minimum":17581.4,"maximum":43183.78,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19534.27,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":43183.78,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17581.4,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","code_information":[{"code":"987","type":"MS-DRG"}],"standard_charges":[{"minimum":12940.33,"maximum":12940.33,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12940.33,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","code_information":[{"code":"988","type":"MS-DRG"}],"standard_charges":[{"minimum":11987.75,"maximum":27848.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12737.05,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27848.84,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27355.87,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11987.75,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Leuprolide acetate","code_information":[{"code":"0800","type":"APC"}],"standard_charges":[{"minimum":1207.5,"maximum":1207.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1207.5,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Visualization adjunct","code_information":[{"code":"1446","type":"APC"}],"standard_charges":[{"minimum":3114.83,"maximum":3114.83,"setting":"outpatient","payers_information":[{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3114.83,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Tetanus immune globulin inj","code_information":[{"code":"1670","type":"APC"}],"standard_charges":[{"minimum":1191.94,"maximum":3599.69,"setting":"outpatient","payers_information":[{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3599.69,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1191.94,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Type A ED Visits","code_information":[{"code":"5021","type":"APC"}],"standard_charges":[{"minimum":74.96,"maximum":1117.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":298.0,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":89.86,"methodology":"other"},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":74.96,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":416.1,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":411.57,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":74.96,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":396.89,"methodology":"other"},{"payer_name":"Georgia Assurance","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":78.81,"methodology":"other"},{"payer_name":"Humana","plan_name":"Choice Care Leased Network All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":766.5,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":76.51,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":116.68,"methodology":"other"},{"payer_name":"PHCS","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":1117.8,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":497.06,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Type A ED Visits","code_information":[{"code":"5022","type":"APC"}],"standard_charges":[{"minimum":86.23,"maximum":1430.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":722.5,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":86.23,"methodology":"other"},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":134.26,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Pathway Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":120.15,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":693.5,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":649.68,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":134.26,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":585.65,"methodology":"other"},{"payer_name":"Humana","plan_name":"Choice Care Leased Network All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1430.75,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":139.5,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":216.23,"methodology":"other"},{"payer_name":"PHCS","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":377.66,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":790.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Type A ED Visits","code_information":[{"code":"5023","type":"APC"}],"standard_charges":[{"minimum":57.68,"maximum":2030.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1866.25,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":371.43,"methodology":"other"},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":251.73,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Pathway Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1665.95,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1792.58,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1875.54,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":363.61,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1549.38,"methodology":"other"},{"payer_name":"Georgia Assurance","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":372.54,"methodology":"other"},{"payer_name":"Humana","plan_name":"Choice Care Leased Network All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1007.0,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":308.95,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":410.12,"methodology":"other"},{"payer_name":"PHCS","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":500.0,"methodology":"percent of total billed charges"},{"payer_name":"Secure Health Plan","plan_name":"Leased Network PPO","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":92.0,"estimated_amount":57.68,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2030.16,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Type A ED Visits","code_information":[{"code":"5024","type":"APC"}],"standard_charges":[{"minimum":394.09,"maximum":4234.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3473.25,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":664.91,"methodology":"other"},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":839.1,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Pathway Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3554.48,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3052.5,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3070.11,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":727.22,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2507.18,"methodology":"other"},{"payer_name":"Georgia Assurance","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":394.09,"methodology":"other"},{"payer_name":"Humana","plan_name":"Choice Care Leased Network All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1540.0,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":588.36,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":521.64,"methodology":"other"},{"payer_name":"PHCS","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":831.74,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4234.65,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 5 Type A ED Visits","code_information":[{"code":"5025","type":"APC"}],"standard_charges":[{"minimum":601.53,"maximum":7186.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5722.56,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":970.62,"methodology":"other"},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":839.1,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6009.15,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6899.44,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":601.53,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4504.77,"methodology":"other"},{"payer_name":"Georgia Assurance","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":864.34,"methodology":"other"},{"payer_name":"Humana","plan_name":"Choice Care Leased Network All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2209.94,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":946.38,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1274.66,"methodology":"other"},{"payer_name":"PHCS","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":5966.52,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7186.66,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Critical Care","code_information":[{"code":"5041","type":"APC"}],"standard_charges":[{"minimum":1135.72,"maximum":7738.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7738.62,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1555.96,"methodology":"other"},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1135.72,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5993.56,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6528.75,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1405.22,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6088.27,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1560.96,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2028.69,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5460.14,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Skin Procedures","code_information":[{"code":"5051","type":"APC"}],"standard_charges":[{"minimum":148.59,"maximum":3262.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1699.62,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":345.28,"methodology":"other"},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":251.73,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2947.13,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1721.51,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":363.61,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1529.38,"methodology":"other"},{"payer_name":"Georgia Assurance","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":148.59,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":283.43,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":515.42,"methodology":"other"},{"payer_name":"PHCS","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":3262.1,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1255.23,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Skin Procedures","code_information":[{"code":"5052","type":"APC"}],"standard_charges":[{"minimum":251.73,"maximum":9067.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2900.12,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":938.52,"methodology":"other"},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":251.73,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5348.0,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9067.0,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":686.44,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2514.9,"methodology":"other"},{"payer_name":"Georgia Assurance","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":613.94,"methodology":"other"},{"payer_name":"Humana","plan_name":"Choice Care Leased Network All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1482.1,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":608.04,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":584.91,"methodology":"other"},{"payer_name":"PHCS","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":4520.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1478.48,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Skin Procedures","code_information":[{"code":"5053","type":"APC"}],"standard_charges":[{"minimum":1036.02,"maximum":4750.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1036.02,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4750.0,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2511.08,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Skin Procedures","code_information":[{"code":"5054","type":"APC"}],"standard_charges":[{"minimum":1599.48,"maximum":31051.0,"setting":"outpatient","payers_information":[{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31051.0,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1599.48,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3649.70,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5071","type":"APC"}],"standard_charges":[{"minimum":434.5,"maximum":4339.50,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2383.84,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":434.5,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3052.5,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1667.14,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4339.50,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":656.48,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5072","type":"APC"}],"standard_charges":[{"minimum":541.73,"maximum":11450.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1558.52,"methodology":"other"},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2574.65,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3003.08,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11450.0,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":541.73,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4332.25,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1247.78,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2217.49,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2796.81,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5073","type":"APC"}],"standard_charges":[{"minimum":7.65,"maximum":17075.0,"setting":"outpatient","payers_information":[{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3134.66,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17075.0,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7.65,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1989.57,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9671.18,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Breast/Lymphatic Surgery and Related Procedures","code_information":[{"code":"5091","type":"APC"}],"standard_charges":[{"minimum":5263.9,"maximum":5263.9,"setting":"outpatient","payers_information":[{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5263.9,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Breast/Lymphatic Surgery and Related Procedures","code_information":[{"code":"5092","type":"APC"}],"standard_charges":[{"minimum":2873.68,"maximum":2873.68,"setting":"outpatient","payers_information":[{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2873.68,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Strapping and Cast Application","code_information":[{"code":"5101","type":"APC"}],"standard_charges":[{"minimum":74.96,"maximum":2826.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1476.0,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":433.5,"methodology":"other"},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":328.71,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1777.20,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2826.16,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":74.96,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1745.52,"methodology":"other"},{"payer_name":"Humana","plan_name":"Choice Care Leased Network All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":781.2,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":481.86,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":306.16,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Musculoskeletal Procedures","code_information":[{"code":"5111","type":"APC"}],"standard_charges":[{"minimum":375.0,"maximum":1028.81,"setting":"outpatient","payers_information":[{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":375.0,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1028.81,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Musculoskeletal Procedures","code_information":[{"code":"5112","type":"APC"}],"standard_charges":[{"minimum":1432.47,"maximum":8943.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6003.99,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6965.17,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2965.63,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2246.61,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8943.08,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1432.47,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2405.39,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3212.05,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Musculoskeletal Procedures","code_information":[{"code":"5113","type":"APC"}],"standard_charges":[{"minimum":2634.3,"maximum":16397.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16397.78,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3185.70,"methodology":"other"},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2778.48,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8732.94,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9509.83,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6414.98,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11357.41,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2634.3,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2880.32,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3065.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Musculoskeletal Procedures","code_information":[{"code":"5114","type":"APC"}],"standard_charges":[{"minimum":2823.46,"maximum":21939.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21939.44,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6878.72,"methodology":"other"},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5513.77,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20216.28,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13676.3,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5017.96,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16978.96,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6278.29,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5004.76,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2823.46,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 5 Musculoskeletal Procedures","code_information":[{"code":"5115","type":"APC"}],"standard_charges":[{"minimum":2686.77,"maximum":42705.09,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":42705.09,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13487.86,"methodology":"other"},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7391.05,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24610.32,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24535.05,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21538.0,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12785.36,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6681.54,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2686.77,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 6 Musculoskeletal Procedures","code_information":[{"code":"5116","type":"APC"}],"standard_charges":[{"minimum":16399.44,"maximum":16399.44,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16399.44,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Airway Endoscopy","code_information":[{"code":"5153","type":"APC"}],"standard_charges":[{"minimum":1652.57,"maximum":2683.75,"setting":"outpatient","payers_information":[{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2683.75,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2539.26,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1652.57,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2578.35,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Airway Endoscopy","code_information":[{"code":"5154","type":"APC"}],"standard_charges":[{"minimum":3657.92,"maximum":13961.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13961.6,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3657.92,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 5 Airway Endoscopy","code_information":[{"code":"5155","type":"APC"}],"standard_charges":[{"minimum":3077.63,"maximum":21087.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6683.0,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18125.85,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13394.56,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21087.76,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6180.14,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3077.63,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 ENT Procedures","code_information":[{"code":"5161","type":"APC"}],"standard_charges":[{"minimum":993.37,"maximum":993.37,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":993.37,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 ENT Procedures","code_information":[{"code":"5163","type":"APC"}],"standard_charges":[{"minimum":2338.02,"maximum":10390.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6046.83,"methodology":"other"},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2338.02,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9099.48,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10390.31,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2596.12,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8794.98,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3094.75,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3065.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 ENT Procedures","code_information":[{"code":"5164","type":"APC"}],"standard_charges":[{"minimum":2160.16,"maximum":19706.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3258.84,"methodology":"other"},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2160.16,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15059.05,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9481.09,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19706.34,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2818.32,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2655.98,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 5 ENT Procedures","code_information":[{"code":"5165","type":"APC"}],"standard_charges":[{"minimum":1446.46,"maximum":11581.43,"setting":"outpatient","payers_information":[{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1446.46,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11581.43,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10441.98,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3853.73,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Vascular Procedures","code_information":[{"code":"5181","type":"APC"}],"standard_charges":[{"minimum":416.55,"maximum":1557.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":416.55,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1557.68,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Vascular Procedures","code_information":[{"code":"5182","type":"APC"}],"standard_charges":[{"minimum":997.66,"maximum":4755.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2462.0,"methodology":"other"},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":997.66,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4755.67,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3854.37,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1175.27,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Vascular Procedures","code_information":[{"code":"5183","type":"APC"}],"standard_charges":[{"minimum":2644.35,"maximum":5293.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4140.83,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2906.29,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5293.72,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4226.07,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2644.35,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Vascular Procedures","code_information":[{"code":"5184","type":"APC"}],"standard_charges":[{"minimum":5295.56,"maximum":5295.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5295.56,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Endovascular Procedures","code_information":[{"code":"5191","type":"APC"}],"standard_charges":[{"minimum":2244.9,"maximum":11415.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11415.92,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3074.81,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5599.27,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6420.35,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2244.9,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8805.18,"methodology":"other"},{"payer_name":"Humana","plan_name":"Choice Care Leased Network All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2501.76,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2902.18,"methodology":"other"},{"payer_name":"PHCS","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":3778.55,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3065.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Endovascular Procedures","code_information":[{"code":"5192","type":"APC"}],"standard_charges":[{"minimum":3071.32,"maximum":8216.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8094.29,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5420.11,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6595.29,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6106.64,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8216.69,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4651.04,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3071.32,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Endovascular Procedures","code_information":[{"code":"5193","type":"APC"}],"standard_charges":[{"minimum":10516.25,"maximum":45358.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":45358.59,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10778.32,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10863.14,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11145.34,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":32917.14,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10516.25,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Endovascular Procedures","code_information":[{"code":"5194","type":"APC"}],"standard_charges":[{"minimum":3104.03,"maximum":32272.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":32272.99,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3104.03,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14569.04,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Implantation Wireless PA Pressure Monitor","code_information":[{"code":"5200","type":"APC"}],"standard_charges":[{"minimum":6414.98,"maximum":6414.98,"setting":"outpatient","payers_information":[{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6414.98,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Pacemaker and Similar Procedures","code_information":[{"code":"5222","type":"APC"}],"standard_charges":[{"minimum":2776.54,"maximum":23790.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8608.13,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9422.63,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18024.81,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23790.14,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8256.58,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2776.54,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Pacemaker and Similar Procedures","code_information":[{"code":"5223","type":"APC"}],"standard_charges":[{"minimum":8656.63,"maximum":30627.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10734.98,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30627.68,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8656.63,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Blood Product Exchange and Related Services","code_information":[{"code":"5241","type":"APC"}],"standard_charges":[{"minimum":367.05,"maximum":14548.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1278.04,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":837.18,"methodology":"other"},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":367.05,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2452.00,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14548.35,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3648.13,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":804.36,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":395.98,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Upper GI Procedures","code_information":[{"code":"5301","type":"APC"}],"standard_charges":[{"minimum":1751.91,"maximum":8106.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1810.08,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8106.13,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2878.38,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1751.91,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7059.54,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Upper GI Procedures","code_information":[{"code":"5302","type":"APC"}],"standard_charges":[{"minimum":1534.88,"maximum":1926.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1926.0,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1534.88,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Lower GI Procedures","code_information":[{"code":"5311","type":"APC"}],"standard_charges":[{"minimum":715.7,"maximum":5267.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4994.64,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":935.42,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5267.76,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4391.06,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":859.22,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3116.72,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":715.7,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2872.38,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Lower GI Procedures","code_information":[{"code":"5312","type":"APC"}],"standard_charges":[{"minimum":789.56,"maximum":9145.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2450.88,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1194.45,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3819.75,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3938.16,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":896.18,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3815.36,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1158.15,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":789.56,"methodology":"other"},{"payer_name":"PHCS","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":9145.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3065.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Abdominal/Peritoneal/Biliary and Related Procedures","code_information":[{"code":"5341","type":"APC"}],"standard_charges":[{"minimum":3366.39,"maximum":24136.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24136.68,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13283.76,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3366.39,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Laparoscopy and Related Services","code_information":[{"code":"5361","type":"APC"}],"standard_charges":[{"minimum":3060.46,"maximum":20270.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5846.34,"methodology":"other"},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3060.46,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19285.07,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11352.72,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3570.96,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20270.21,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4484.19,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3995.72,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Laparoscopy and Related Services","code_information":[{"code":"5362","type":"APC"}],"standard_charges":[{"minimum":18444.32,"maximum":18444.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18444.32,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Urology and Related Services","code_information":[{"code":"5372","type":"APC"}],"standard_charges":[{"minimum":503.50,"maximum":5078.85,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":503.50,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5078.85,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Urology and Related Services","code_information":[{"code":"5373","type":"APC"}],"standard_charges":[{"minimum":1293.45,"maximum":21538.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1886.05,"methodology":"other"},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2514.01,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9221.42,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6603.24,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21538.0,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2631.81,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3839.35,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1293.45,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Urology and Related Services","code_information":[{"code":"5374","type":"APC"}],"standard_charges":[{"minimum":3181.13,"maximum":11550.2,"setting":"outpatient","payers_information":[{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11550.2,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3181.13,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4913.17,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 5 Urology and Related Services","code_information":[{"code":"5375","type":"APC"}],"standard_charges":[{"minimum":8513.50,"maximum":18666.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18666.05,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15335.78,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8513.50,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Dialysis","code_information":[{"code":"5401","type":"APC"}],"standard_charges":[{"minimum":3175.55,"maximum":3175.55,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3175.55,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Gynecologic Procedures","code_information":[{"code":"5411","type":"APC"}],"standard_charges":[{"minimum":195.0,"maximum":1369.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":410.13,"methodology":"other"},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":243.61,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":567.94,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":763.7,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":275.63,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":600.98,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":219.59,"methodology":"other"},{"payer_name":"PHCS","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":195.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1369.86,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Gynecologic Procedures","code_information":[{"code":"5412","type":"APC"}],"standard_charges":[{"minimum":1797.04,"maximum":1797.04,"setting":"outpatient","payers_information":[{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1797.04,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Nerve Procedures","code_information":[{"code":"5431","type":"APC"}],"standard_charges":[{"minimum":1487.05,"maximum":11983.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10478.43,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1660.16,"methodology":"other"},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2600.62,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11983.64,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8182.42,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8030.27,"methodology":"other"},{"payer_name":"Georgia Assurance","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1487.05,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1528.48,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2287.74,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Nerve Injections","code_information":[{"code":"5441","type":"APC"}],"standard_charges":[{"minimum":159.90,"maximum":257.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":159.90,"methodology":"other"},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":181.47,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":257.58,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":209.42,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Nerve Injections","code_information":[{"code":"5442","type":"APC"}],"standard_charges":[{"minimum":619.62,"maximum":29332.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1211.76,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1645.64,"methodology":"other"},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2251.74,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7638.19,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17997.5,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":619.62,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17936.4,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1449.88,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2230.79,"methodology":"other"},{"payer_name":"PHCS","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":29332.8,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2911.75,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Nerve Injections","code_information":[{"code":"5443","type":"APC"}],"standard_charges":[{"minimum":1217.34,"maximum":23814.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23814.37,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4993.38,"methodology":"other"},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1217.34,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13045.86,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6425.36,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16628.99,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7007.38,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2953.31,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3002.58,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Intraocular Procedures","code_information":[{"code":"5491","type":"APC"}],"standard_charges":[{"minimum":1901.08,"maximum":8343.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4833.91,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2244.37,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7810.78,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8343.53,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8018.48,"methodology":"other"},{"payer_name":"Humana","plan_name":"Choice Care Leased Network All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2274.05,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1901.08,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2850.45,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Intraocular Procedures","code_information":[{"code":"5492","type":"APC"}],"standard_charges":[{"minimum":3904.51,"maximum":3904.51,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3904.51,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Imaging without Contrast","code_information":[{"code":"5521","type":"APC"}],"standard_charges":[{"minimum":22.22,"maximum":507.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":260.4,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":90.3,"methodology":"other"},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":74.81,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":143.89,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":177.98,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":79.98,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":373.19,"methodology":"other"},{"payer_name":"Georgia Assurance","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22.22,"methodology":"other"},{"payer_name":"Humana","plan_name":"Choice Care Leased Network All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":88.53,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":87.12,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":95.12,"methodology":"other"},{"payer_name":"PHCS","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":135.27,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":507.06,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Imaging without Contrast","code_information":[{"code":"5522","type":"APC"}],"standard_charges":[{"minimum":25.0,"maximum":2851.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":429.78,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":111.28,"methodology":"other"},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":154.43,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Pathway Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2851.32,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":487.11,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":465.73,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":153.80,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":673.0,"methodology":"other"},{"payer_name":"Georgia Assurance","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":99.24,"methodology":"other"},{"payer_name":"Humana","plan_name":"Choice Care Leased Network All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25.0,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":107.39,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":197.90,"methodology":"other"},{"payer_name":"PHCS","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":617.6,"methodology":"percent of total billed charges"},{"payer_name":"Secure Health Plan","plan_name":"Leased Network PPO","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":92.0,"estimated_amount":203.46,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":772.49,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Imaging without Contrast","code_information":[{"code":"5523","type":"APC"}],"standard_charges":[{"minimum":151.58,"maximum":1154.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":630.0,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":242.7,"methodology":"other"},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":268.65,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Pathway Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":698.85,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":853.18,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1106.14,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":279.97,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1154.54,"methodology":"other"},{"payer_name":"Humana","plan_name":"Choice Care Leased Network All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":151.58,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":236.63,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":266.68,"methodology":"other"},{"payer_name":"PHCS","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":638.24,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1093.98,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Imaging without Contrast","code_information":[{"code":"5524","type":"APC"}],"standard_charges":[{"minimum":418.35,"maximum":2630.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1404.02,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":617.92,"methodology":"other"},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":418.35,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2240.94,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2040.28,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":433.4,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1980.33,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":512.18,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":549.14,"methodology":"other"},{"payer_name":"PHCS","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":421.18,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2630.16,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Imaging with Contrast","code_information":[{"code":"5571","type":"APC"}],"standard_charges":[{"minimum":105.84,"maximum":658.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":485.53,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":187.44,"methodology":"other"},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":172.61,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":658.5,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":606.82,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":105.84,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":654.35,"methodology":"other"},{"payer_name":"Georgia Assurance","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":153.71,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":180.08,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":127.86,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":641.98,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Imaging with Contrast","code_information":[{"code":"5572","type":"APC"}],"standard_charges":[{"minimum":251.73,"maximum":6457.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4065.7,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":389.26,"methodology":"other"},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":251.73,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1868.12,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6457.76,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":363.61,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6215.64,"methodology":"other"},{"payer_name":"Georgia Assurance","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":308.17,"methodology":"other"},{"payer_name":"Humana","plan_name":"Choice Care Leased Network All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1518.38,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":517.79,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1959.13,"methodology":"other"},{"payer_name":"PHCS","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":952.5,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2708.1,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Imaging with Contrast","code_information":[{"code":"5573","type":"APC"}],"standard_charges":[{"minimum":456.34,"maximum":2823.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1984.72,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":959.75,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2195.1,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1222.44,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":456.34,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1795.04,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":922.11,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":558.64,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2823.58,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Nuclear Medicine and Related Services","code_information":[{"code":"5591","type":"APC"}],"standard_charges":[{"minimum":396.94,"maximum":3855.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":468.58,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2060.67,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1626.37,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":697.20,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3074.5,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":396.94,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3855.14,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Nuclear Medicine and Related Services","code_information":[{"code":"5592","type":"APC"}],"standard_charges":[{"minimum":357.1,"maximum":3435.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2722.72,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":357.1,"methodology":"other"},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":612.42,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2886.88,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2148.39,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":555.81,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1967.73,"methodology":"other"},{"payer_name":"Georgia Assurance","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":506.52,"methodology":"other"},{"payer_name":"Humana","plan_name":"Choice Care Leased Network All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":942.84,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":503.78,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":676.46,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3435.27,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Nuclear Medicine and Related Services","code_information":[{"code":"5593","type":"APC"}],"standard_charges":[{"minimum":1330.79,"maximum":7121.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4402.14,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1379.46,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4832.24,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5140.26,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4987.66,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1330.79,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1817.93,"methodology":"other"},{"payer_name":"PHCS","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":1893.39,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7121.92,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Nuclear Medicine and Related Services","code_information":[{"code":"5594","type":"APC"}],"standard_charges":[{"minimum":1243.25,"maximum":3131.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1558.2,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1340.72,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3131.82,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1800.0,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1243.25,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Pathology","code_information":[{"code":"5671","type":"APC"}],"standard_charges":[{"minimum":52.71,"maximum":6617.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2730.16,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":54.85,"methodology":"other"},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2464.31,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4931.53,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3656.66,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2566.05,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6617.34,"methodology":"other"},{"payer_name":"Humana","plan_name":"Choice Care Leased Network All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2450.19,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":52.71,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2452.69,"methodology":"other"},{"payer_name":"PHCS","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":252.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1370.66,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Pathology","code_information":[{"code":"5672","type":"APC"}],"standard_charges":[{"minimum":87.57,"maximum":8517.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":87.57,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1029.87,"methodology":"other"},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":111.38,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8517.56,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":416.0,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":326.25,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":166.11,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1861.54,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2029.68,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Pathology","code_information":[{"code":"5673","type":"APC"}],"standard_charges":[{"minimum":336.61,"maximum":59486.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":59486.94,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1048.31,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4594.40,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4628.09,"methodology":"other"},{"payer_name":"Georgia Assurance","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1540.71,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":336.61,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1361.79,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1705.44,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Pathology","code_information":[{"code":"5674","type":"APC"}],"standard_charges":[{"minimum":60557.07,"maximum":60557.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":60557.07,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Drug Administration","code_information":[{"code":"5692","type":"APC"}],"standard_charges":[{"minimum":100.0,"maximum":1550.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1506.33,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1550.68,"methodology":"other"},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":105.05,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1027.02,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1474.58,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":138.28,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":100.0,"methodology":"other"},{"payer_name":"Georgia Assurance","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":286.95,"methodology":"other"},{"payer_name":"Humana","plan_name":"Choice Care Leased Network All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1193.07,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1525.32,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":111.7,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":503.72,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Drug Administration","code_information":[{"code":"5693","type":"APC"}],"standard_charges":[{"minimum":364.06,"maximum":3516.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1585.79,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":665.51,"methodology":"other"},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":745.29,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2722.63,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3400.36,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":364.06,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2500.75,"methodology":"other"},{"payer_name":"Georgia Assurance","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1290.24,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":679.42,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":763.32,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3516.89,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Drug Administration","code_information":[{"code":"5694","type":"APC"}],"standard_charges":[{"minimum":542.56,"maximum":2892.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":542.56,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2892.19,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":817.52,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Diagnostic Tests and Related Services","code_information":[{"code":"5721","type":"APC"}],"standard_charges":[{"minimum":146.48,"maximum":1251.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1251.0,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":176.14,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":923.7,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":749.54,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1042.5,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":146.48,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":248.62,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Diagnostic Tests and Related Services","code_information":[{"code":"5722","type":"APC"}],"standard_charges":[{"minimum":237.63,"maximum":1715.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1146.0,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":291.08,"methodology":"other"},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":237.63,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1059.66,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1715.08,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":293.2,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":988.70,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":280.66,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":271.72,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":853.43,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Diagnostic Tests and Related Services","code_information":[{"code":"5723","type":"APC"}],"standard_charges":[{"minimum":437.22,"maximum":2054.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1249.16,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":502.45,"methodology":"other"},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":458.56,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1732.47,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1988.02,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":437.22,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2054.32,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":482.74,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":461.71,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Diagnostic Tests and Related Services","code_information":[{"code":"5724","type":"APC"}],"standard_charges":[{"minimum":948.18,"maximum":5382.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3413.70,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1055.28,"methodology":"other"},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1376.19,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5382.22,"methodology":"other"},{"payer_name":"Georgia Assurance","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1051.55,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":948.18,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1433.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Minor Procedures","code_information":[{"code":"5731","type":"APC"}],"standard_charges":[{"minimum":24.92,"maximum":190.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":145.56,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25.95,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":190.02,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":158.12,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":142.96,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24.92,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":35.47,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":180.12,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Minor Procedures","code_information":[{"code":"5732","type":"APC"}],"standard_charges":[{"minimum":30.72,"maximum":88.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":36.75,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":35.29,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":88.49,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":41.65,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":50.74,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30.72,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":34.01,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":36.78,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Minor Procedures","code_information":[{"code":"5733","type":"APC"}],"standard_charges":[{"minimum":119.84,"maximum":8175.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8175.99,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1564.06,"methodology":"other"},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":119.84,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7168.32,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6978.28,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1482.14,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6357.73,"methodology":"other"},{"payer_name":"Georgia Assurance","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2820.38,"methodology":"other"},{"payer_name":"Humana","plan_name":"Choice Care Leased Network All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":125.0,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2461.17,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":124.67,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":504.01,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Minor Procedures","code_information":[{"code":"5734","type":"APC"}],"standard_charges":[{"minimum":109.3,"maximum":8585.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":454.53,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":109.3,"methodology":"other"},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":380.58,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5381.82,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3754.68,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":175.35,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8585.35,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":118.31,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":307.81,"methodology":"other"},{"payer_name":"PHCS","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":129.74,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1134.28,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Electronic Analysis of Devices","code_information":[{"code":"5741","type":"APC"}],"standard_charges":[{"minimum":28.8,"maximum":294.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":294.75,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":36.37,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":266.86,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":222.62,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":268.36,"methodology":"other"},{"payer_name":"Georgia Assurance","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28.8,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":34.96,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":61.13,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cardiac Rehabilitation","code_information":[{"code":"5771","type":"APC"}],"standard_charges":[{"minimum":748.74,"maximum":4939.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4258.12,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":748.74,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4469.2,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4939.82,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3797.12,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":771.09,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4186.21,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Resuscitation and Cardioversion","code_information":[{"code":"5781","type":"APC"}],"standard_charges":[{"minimum":1060.70,"maximum":4131.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1140.27,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4131.01,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3146.52,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3404.47,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1060.70,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Pulmonary Treatment","code_information":[{"code":"5791","type":"APC"}],"standard_charges":[{"minimum":246.59,"maximum":5941.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1911.37,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5941.42,"methodology":"other"},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":251.73,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":407.98,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1968.98,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":363.61,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1742.65,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":246.59,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":465.34,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3065.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Alteplase recombinant","code_information":[{"code":"7048","type":"APC"}],"standard_charges":[{"minimum":2495.21,"maximum":2495.21,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2495.21,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Ultrasound Composite","code_information":[{"code":"8004","type":"APC"}],"standard_charges":[{"minimum":324.81,"maximum":1094.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":324.81,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":848.50,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1094.79,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":348.31,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":767.96,"methodology":"other"}],"billing_class":"facility"}]},{"description":"CT and CTA without Contrast Composite","code_information":[{"code":"8005","type":"APC"}],"standard_charges":[{"minimum":135.18,"maximum":1490.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":304.69,"methodology":"other"},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":848.54,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":591.64,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":750.2,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":135.18,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1211.4,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":369.45,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1490.07,"methodology":"other"}],"billing_class":"facility"}]},{"description":"CT and CTA with Contrast Composite","code_information":[{"code":"8006","type":"APC"}],"standard_charges":[{"minimum":248.39,"maximum":15985.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":943.76,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":505.32,"methodology":"other"},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":248.39,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11161.10,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10706.12,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":698.73,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11000.63,"methodology":"other"},{"payer_name":"Georgia Assurance","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":357.24,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":932.66,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4568.26,"methodology":"other"},{"payer_name":"PHCS","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":619.35,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15985.16,"methodology":"other"}],"billing_class":"facility"}]},{"description":"MRI and MRA without Contrast Composite","code_information":[{"code":"8007","type":"APC"}],"standard_charges":[{"minimum":529.10,"maximum":2844.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1134.0,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":569.09,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1872.45,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1144.68,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":559.94,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2004.64,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":529.10,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2844.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"MRI and MRA with Contrast Composite","code_information":[{"code":"8008","type":"APC"}],"standard_charges":[{"minimum":603.09,"maximum":41406.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1197.94,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":671.14,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2222.40,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2496.6,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":603.09,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13558.78,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":852.11,"methodology":"other"},{"payer_name":"PHCS","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":1463.7,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":41406.13,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Comprehensive Observation Services","code_information":[{"code":"8011","type":"APC"}],"standard_charges":[{"minimum":809.84,"maximum":15574.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13926.48,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2658.02,"methodology":"other"},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":986.59,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11140.68,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11129.75,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":809.84,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12467.4,"methodology":"other"},{"payer_name":"Georgia Assurance","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2262.92,"methodology":"other"},{"payer_name":"Humana","plan_name":"Choice Care Leased Network All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15574.97,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2551.22,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3479.99,"methodology":"other"},{"payer_name":"PHCS","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":5277.96,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11413.88,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Glucagon hydrochloride","code_information":[{"code":"9042","type":"APC"}],"standard_charges":[{"minimum":793.75,"maximum":793.75,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":793.75,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Rabies vaccine, im","code_information":[{"code":"9139","type":"APC"}],"standard_charges":[{"minimum":278.47,"maximum":5054.72,"setting":"outpatient","payers_information":[{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1344.02,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1097.13,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5054.72,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":278.47,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":698.22,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1126.28,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Crotalidae Poly Immune Fab","code_information":[{"code":"9274","type":"APC"}],"standard_charges":[{"minimum":25957.88,"maximum":25957.88,"setting":"outpatient","payers_information":[{"payer_name":"PHCS","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":25957.88,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Inj, clindamycin (baxter)","code_information":[{"code":"9292","type":"APC"}],"standard_charges":[{"minimum":3381.63,"maximum":9468.24,"setting":"outpatient","payers_information":[{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6342.64,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9468.24,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3381.63,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Platelet pheres leukoreduced","code_information":[{"code":"9501","type":"APC"}],"standard_charges":[{"minimum":1477.62,"maximum":3052.51,"setting":"outpatient","payers_information":[{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3052.51,"methodology":"other"},{"payer_name":"Georgia Assurance","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1477.62,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Clinical Diagnostic Lab Services","code_information":[{"code":"N800","type":"APC"}],"standard_charges":[{"minimum":23.79,"maximum":113.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":108.55,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29.69,"methodology":"other"},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23.79,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":65.0,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":79.08,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":46.94,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":86.88,"methodology":"other"},{"payer_name":"Georgia Assurance","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":35.90,"methodology":"other"},{"payer_name":"Humana","plan_name":"Choice Care Leased Network All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":57.54,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":32.24,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":49.04,"methodology":"other"},{"payer_name":"PHCS","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":113.78,"methodology":"percent of total billed charges"},{"payer_name":"Secure Health Plan","plan_name":"Leased Network PPO","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":92.0,"estimated_amount":94.76,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":108.23,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Therapy Services","code_information":[{"code":"N801","type":"APC"}],"standard_charges":[{"minimum":101.7,"maximum":2085.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1098.27,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":303.57,"methodology":"other"},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":316.21,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Pathway Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":527.32,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1844.71,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1787.16,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":343.43,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1627.0,"methodology":"other"},{"payer_name":"Humana","plan_name":"Choice Care Leased Network All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":101.7,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":321.85,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":251.34,"methodology":"other"},{"payer_name":"PHCS","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":796.29,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2085.6,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Mammography Services","code_information":[{"code":"N804","type":"APC"}],"standard_charges":[{"minimum":81.09,"maximum":668.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":298.30,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":84.39,"methodology":"other"},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":105.66,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Pathway Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":536.59,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":596.21,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":596.21,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":115.56,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":465.86,"methodology":"other"},{"payer_name":"First Health","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":668.7,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Choice Care Leased Network All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":557.25,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":81.09,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":110.08,"methodology":"other"},{"payer_name":"PHCS","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":176.48,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":586.97,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Packaged Services","code_information":[{"code":"N902","type":"APC"}],"standard_charges":[{"minimum":829.85,"maximum":3928.80,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3928.80,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":925.09,"methodology":"other"},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1285.86,"methodology":"other"},{"payer_name":"BCBS","plan_name":"HMO/POS","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3819.75,"methodology":"other"},{"payer_name":"BCBS","plan_name":"PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3819.75,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1607.62,"methodology":"other"},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3325.76,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":829.85,"methodology":"other"},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":965.77,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3065.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Not Billable to FI","code_information":[{"code":"N907","type":"APC"}],"standard_charges":[{"minimum":6263.69,"maximum":6263.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6263.69,"methodology":"other"}],"billing_class":"facility"}]}],"modifier_information":[{"description":"Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha","code":"TC","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Beechstreet","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Contigo COE","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum","plan_name":"Behavioral Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State Health Plan","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sonder Health Plans","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient speech language pathology plan of care","code":"GN","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Beechstreet","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Contigo COE","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum","plan_name":"Behavioral Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State Health Plan","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sonder Health Plans","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient physical therapy plan of care","code":"GP","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Beechstreet","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Contigo COE","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum","plan_name":"Behavioral Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State Health Plan","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sonder Health Plans","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient occupational therapy plan of care","code":"GO","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Beechstreet","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Contigo COE","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum","plan_name":"Behavioral Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State Health Plan","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sonder Health Plans","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the same day of the Procedure or Other Service","code":"25","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Beechstreet","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Contigo COE","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum","plan_name":"Behavioral Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State Health Plan","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sonder Health Plans","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha","code":"TC","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Beechstreet","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum","plan_name":"Behavioral Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State Health Plan","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sonder Health Plans","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"URN","plan_name":"Transplant","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient speech language pathology plan of care","code":"GN","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Beechstreet","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum","plan_name":"Behavioral Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State Health Plan","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sonder Health Plans","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"URN","plan_name":"Transplant","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient physical therapy plan of care","code":"GP","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Beechstreet","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum","plan_name":"Behavioral Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State Health Plan","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sonder Health Plans","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"URN","plan_name":"Transplant","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient occupational therapy plan of care","code":"GO","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Beechstreet","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum","plan_name":"Behavioral Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State Health Plan","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sonder Health Plans","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"URN","plan_name":"Transplant","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the same day of the Procedure or Other Service","code":"25","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Beechstreet","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum","plan_name":"Behavioral Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State Health Plan","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sonder Health Plans","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"URN","plan_name":"Transplant","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha","code":"TC","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Beechstreet","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Contigo COE","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum","plan_name":"Behavioral Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State Health Plan","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sonder Health Plans","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"URN","plan_name":"Transplant","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient speech language pathology plan of care","code":"GN","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Beechstreet","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Contigo COE","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum","plan_name":"Behavioral Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State Health Plan","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sonder Health Plans","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"URN","plan_name":"Transplant","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient physical therapy plan of care","code":"GP","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Beechstreet","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Contigo COE","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum","plan_name":"Behavioral Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State Health Plan","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sonder Health Plans","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"URN","plan_name":"Transplant","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient occupational therapy plan of care","code":"GO","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Beechstreet","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Contigo COE","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum","plan_name":"Behavioral Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State Health Plan","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sonder Health Plans","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"URN","plan_name":"Transplant","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the same day of the Procedure or Other Service","code":"25","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Beechstreet","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Contigo COE","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum","plan_name":"Behavioral Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State Health Plan","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sonder Health Plans","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"URN","plan_name":"Transplant","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha","code":"TC","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Beechstreet","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State Health Plan","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sonder Health Plans","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"URN","plan_name":"Transplant","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient speech language pathology plan of care","code":"GN","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Beechstreet","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State Health Plan","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sonder Health Plans","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"URN","plan_name":"Transplant","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient physical therapy plan of care","code":"GP","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Beechstreet","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State Health Plan","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sonder Health Plans","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"URN","plan_name":"Transplant","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient occupational therapy plan of care","code":"GO","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Beechstreet","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State Health Plan","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sonder Health Plans","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"URN","plan_name":"Transplant","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the same day of the Procedure or Other Service","code":"25","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Beechstreet","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State Health Plan","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sonder Health Plans","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"URN","plan_name":"Transplant","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha","code":"TC","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Beechstreet","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State Health Plan","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sonder Health Plans","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient speech language pathology plan of care","code":"GN","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Beechstreet","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State Health Plan","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sonder Health Plans","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient physical therapy plan of care","code":"GP","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Beechstreet","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State Health Plan","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sonder Health Plans","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient occupational therapy plan of care","code":"GO","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Beechstreet","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State Health Plan","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sonder Health Plans","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the same day of the Procedure or Other Service","code":"25","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Beechstreet","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State Health Plan","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sonder Health Plans","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha","code":"TC","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum","plan_name":"Behavioral Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State Health Plan","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sonder Health Plans","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"URN","plan_name":"Transplant","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient speech language pathology plan of care","code":"GN","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum","plan_name":"Behavioral Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State Health Plan","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sonder Health Plans","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"URN","plan_name":"Transplant","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient physical therapy plan of care","code":"GP","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum","plan_name":"Behavioral Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State Health Plan","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sonder Health Plans","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"URN","plan_name":"Transplant","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient occupational therapy plan of care","code":"GO","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum","plan_name":"Behavioral Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State Health Plan","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sonder Health Plans","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"URN","plan_name":"Transplant","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the same day of the Procedure or Other Service","code":"25","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum","plan_name":"Behavioral Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State Health Plan","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sonder Health Plans","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"URN","plan_name":"Transplant","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha","code":"TC","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State Health Plan","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient speech language pathology plan of care","code":"GN","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State Health Plan","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient physical therapy plan of care","code":"GP","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State Health Plan","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient occupational therapy plan of care","code":"GO","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State Health Plan","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the same day of the Procedure or Other Service","code":"25","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State Health Plan","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha","code":"TC","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State Health Plan","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient speech language pathology plan of care","code":"GN","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State Health Plan","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient physical therapy plan of care","code":"GP","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State Health Plan","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient occupational therapy plan of care","code":"GO","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State Health Plan","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the same day of the Procedure or Other Service","code":"25","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State Health Plan","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Professional Component","code":"26","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"AHMC","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alta Med","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Anthem Exchange - HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross - Intercommunity","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross - Queen of the Valley","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"QVH PPO/EPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"California Children Services","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareMore","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna - Intercommunity","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna - Queen of the Valley","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"CVIP","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"CVPG","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"First Health All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Heritage Provider Network","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser - Intercommunity","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser - Queen of the Valley","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"LA Care","plan_name":"CVPG Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Provider Health Network","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Payer Appendix Choice All Commercial Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Clia waived test","code":"QW","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"AHMC","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alta Med","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Anthem Exchange - HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross - Intercommunity","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross - Queen of the Valley","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"QVH PPO/EPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"California Children Services","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareMore","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna - Intercommunity","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna - Queen of the Valley","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"CVIP","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"CVPG","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"First Health All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Heritage Provider Network","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser - Intercommunity","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser - Queen of the Valley","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"LA Care","plan_name":"CVPG Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Provider Health Network","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Payer Appendix Choice All Commercial Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient physical therapy plan of care","code":"GP","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"AHMC","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alta Med","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Anthem Exchange - HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross - Intercommunity","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross - Queen of the Valley","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"QVH PPO/EPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"California Children Services","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareMore","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna - Intercommunity","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna - Queen of the Valley","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"CVIP","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"CVPG","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"First Health All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Heritage Provider Network","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser - Intercommunity","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser - Queen of the Valley","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"LA Care","plan_name":"CVPG Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Provider Health Network","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Payer Appendix Choice All Commercial Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Left side (used to identify procedures performed on the left side of the body)","code":"LT","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"AHMC","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alta Med","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Anthem Exchange - HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross - Intercommunity","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross - Queen of the Valley","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"QVH PPO/EPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"California Children Services","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareMore","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna - Intercommunity","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna - Queen of the Valley","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"CVIP","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"CVPG","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"First Health All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Heritage Provider Network","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser - Intercommunity","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser - Queen of the Valley","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"LA Care","plan_name":"CVPG Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Provider Health Network","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Payer Appendix Choice All Commercial Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Right side (used to identify procedures performed on the right side of the body)","code":"RT","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"AHMC","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alta Med","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Anthem Exchange - HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross - Intercommunity","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross - Queen of the Valley","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"QVH PPO/EPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"California Children Services","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareMore","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna - Intercommunity","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna - Queen of the Valley","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"CVIP","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"CVPG","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"First Health All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Heritage Provider Network","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser - Intercommunity","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser - Queen of the Valley","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"LA Care","plan_name":"CVPG Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Provider Health Network","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Payer Appendix Choice All Commercial Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Bilateral Procedure","code":"50","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"AHMC","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alta Med","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Anthem Exchange - HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross - Intercommunity","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross - Queen of the Valley","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"QVH PPO/EPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"California Children Services","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareMore","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna - Intercommunity","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna - Queen of the Valley","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"CVIP","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"CVPG","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"First Health All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Heritage Provider Network","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser - Intercommunity","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser - Queen of the Valley","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"LA Care","plan_name":"CVPG Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Provider Health Network","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Payer Appendix Choice All Commercial Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha","code":"TC","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"AHMC","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alta Med","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Anthem Exchange - HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross - Intercommunity","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross - Queen of the Valley","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"QVH PPO/EPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"California Children Services","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareMore","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna - Intercommunity","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna - Queen of the Valley","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"CVIP","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"CVPG","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"First Health All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Heritage Provider Network","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser - Intercommunity","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser - Queen of the Valley","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"LA Care","plan_name":"CVPG Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Provider Health Network","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Payer Appendix Choice All Commercial Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Requirements specified in the medical policy have been met","code":"KX","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"AHMC","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alta Med","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Anthem Exchange - HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross - Intercommunity","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross - Queen of the Valley","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"QVH PPO/EPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"California Children Services","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareMore","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna - Intercommunity","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna - Queen of the Valley","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"CVIP","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"CVPG","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"First Health All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Heritage Provider Network","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser - Intercommunity","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser - Queen of the Valley","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"LA Care","plan_name":"CVPG Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Provider Health Network","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Payer Appendix Choice All Commercial Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Computed tomography services furnished using equipment that does not meet each of the attributes of the national electrical manufacturers association (nema) xr-29-2013 standard","code":"CT","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"AHMC","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alta Med","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Anthem Exchange - HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross - Intercommunity","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross - Queen of the Valley","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"QVH PPO/EPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"California Children Services","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareMore","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna - Intercommunity","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna - Queen of the Valley","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"CVIP","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"CVPG","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"First Health All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Heritage Provider Network","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser - Intercommunity","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser - Queen of the Valley","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"LA Care","plan_name":"CVPG Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Provider Health Network","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Payer Appendix Choice All Commercial Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient occupational therapy plan of care","code":"GO","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"AHMC","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alta Med","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Anthem Exchange - HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross - Intercommunity","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross - Queen of the Valley","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"QVH PPO/EPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"California Children Services","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareMore","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna - Intercommunity","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna - Queen of the Valley","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"CVIP","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"CVPG","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"First Health All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Heritage Provider Network","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser - Intercommunity","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser - Queen of the Valley","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"LA Care","plan_name":"CVPG Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Provider Health Network","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Payer Appendix Choice All Commercial Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient speech language pathology plan of care","code":"GN","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"AHMC","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alta Med","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Anthem Exchange - HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross - Intercommunity","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross - Queen of the Valley","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"QVH PPO/EPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"California Children Services","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareMore","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna - Intercommunity","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna - Queen of the Valley","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"CVIP","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"CVPG","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"First Health All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Heritage Provider Network","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser - Intercommunity","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser - Queen of the Valley","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"LA Care","plan_name":"CVPG Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Provider Health Network","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Payer Appendix Choice All Commercial Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Catastrophe/disaster related","code":"CR","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"AHMC","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alta Med","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Anthem Exchange - HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross - Intercommunity","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross - Queen of the Valley","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"QVH PPO/EPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"California Children Services","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareMore","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna - Intercommunity","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna - Queen of the Valley","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"CVIP","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"CVPG","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"First Health All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Heritage Provider Network","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser - Intercommunity","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser - Queen of the Valley","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"LA Care","plan_name":"CVPG Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Provider Health Network","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Payer Appendix Choice All Commercial Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Professional Component","code":"26","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"AHMC","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alhambra","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alta Med","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"CVIP","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"CVPG","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"First Health All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Heritage Provider Network","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"LA Care","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Provider Health Network","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Payer Appendix Choice All Commercial Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Clia waived test","code":"QW","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"AHMC","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alhambra","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alta Med","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"CVIP","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"CVPG","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"First Health All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Heritage Provider Network","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"LA Care","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Provider Health Network","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Payer Appendix Choice All Commercial Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Left side (used to identify procedures performed on the left side of the body)","code":"LT","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"AHMC","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alhambra","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alta Med","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"CVIP","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"CVPG","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"First Health All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Heritage Provider Network","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"LA Care","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Provider Health Network","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Payer Appendix Choice All Commercial Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Right side (used to identify procedures performed on the right side of the body)","code":"RT","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"AHMC","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alhambra","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alta Med","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"CVIP","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"CVPG","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"First Health All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Heritage Provider Network","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"LA Care","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Provider Health Network","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Payer Appendix Choice All Commercial Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Bilateral Procedure","code":"50","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"AHMC","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alhambra","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alta Med","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"CVIP","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"CVPG","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"First Health All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Heritage Provider Network","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"LA Care","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Provider Health Network","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Payer Appendix Choice All Commercial Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha","code":"TC","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"AHMC","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alhambra","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alta Med","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"CVIP","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"CVPG","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"First Health All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Heritage Provider Network","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"LA Care","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Provider Health Network","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Payer Appendix Choice All Commercial Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Requirements specified in the medical policy have been met","code":"KX","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"AHMC","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alhambra","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alta Med","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"CVIP","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"CVPG","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"First Health All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Heritage Provider Network","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"LA Care","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Provider Health Network","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Payer Appendix Choice All Commercial Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Computed tomography services furnished using equipment that does not meet each of the attributes of the national electrical manufacturers association (nema) xr-29-2013 standard","code":"CT","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"AHMC","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alhambra","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alta Med","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"CVIP","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"CVPG","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"First Health All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Heritage Provider Network","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"LA Care","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Provider Health Network","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Payer Appendix Choice All Commercial Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient physical therapy plan of care","code":"GP","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"AHMC","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alhambra","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alta Med","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"CVIP","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"CVPG","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"First Health All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Heritage Provider Network","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"LA Care","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Provider Health Network","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Payer Appendix Choice All Commercial Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient speech language pathology plan of care","code":"GN","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"AHMC","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alhambra","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alta Med","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"CVIP","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"CVPG","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"First Health All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Heritage Provider Network","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"LA Care","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Provider Health Network","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Payer Appendix Choice All Commercial Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient occupational therapy plan of care","code":"GO","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"AHMC","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alhambra","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alta Med","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"CVIP","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"CVPG","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"First Health All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Heritage Provider Network","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"LA Care","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Provider Health Network","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Payer Appendix Choice All Commercial Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Catastrophe/disaster related","code":"CR","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Gatekeeper All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"AHMC","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alhambra","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alta Med","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"CVIP","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"CVPG","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"First Health All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Heritage Provider Network","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"LA Care","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Provider Health Network","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Payer Appendix Choice All Commercial Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Bilateral Procedure","code":"50","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Blue Access Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Centene","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthlink","plan_name":"Anthem Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"PHCS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Orschein","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Access","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Providers Partners Healthplan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Samaritan Hospital","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Left side (used to identify procedures performed on the left side of the body)","code":"LT","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Blue Access Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Centene","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthlink","plan_name":"Anthem Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"PHCS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Orschein","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Access","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Providers Partners Healthplan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Samaritan Hospital","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Right side (used to identify procedures performed on the right side of the body)","code":"RT","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Blue Access Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Centene","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthlink","plan_name":"Anthem Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"PHCS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Orschein","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Access","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Providers Partners Healthplan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Samaritan Hospital","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Distinct Procedural Service","code":"59","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Blue Access Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Centene","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthlink","plan_name":"Anthem Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"PHCS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Orschein","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Access","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Providers Partners Healthplan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Samaritan Hospital","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Performance and payment of a screening mammogram and diagnostic mammogram on the same patient, same day","code":"GG","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Blue Access Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Centene","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthlink","plan_name":"Anthem Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"PHCS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Orschein","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Access","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Providers Partners Healthplan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Samaritan Hospital","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional","code":"76","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Blue Access Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Centene","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthlink","plan_name":"Anthem Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"PHCS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Orschein","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Access","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Providers Partners Healthplan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Samaritan Hospital","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient physical therapy plan of care","code":"GP","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Blue Access Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Centene","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthlink","plan_name":"Anthem Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"PHCS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Orschein","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Access","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Providers Partners Healthplan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Samaritan Hospital","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient occupational therapy plan of care","code":"GO","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Blue Access Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Centene","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthlink","plan_name":"Anthem Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"PHCS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Orschein","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Access","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Providers Partners Healthplan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Samaritan Hospital","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient speech language pathology plan of care","code":"GN","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Blue Access Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Centene","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthlink","plan_name":"Anthem Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"PHCS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Orschein","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Access","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Providers Partners Healthplan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Samaritan Hospital","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the same day of the Procedure or Other Service","code":"25","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Blue Access Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Centene","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthlink","plan_name":"Anthem Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"PHCS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Orschein","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Access","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Providers Partners Healthplan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Samaritan Hospital","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit","code":"GY","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Blue Access Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Centene","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthlink","plan_name":"Anthem Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"PHCS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Orschein","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Access","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Providers Partners Healthplan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Samaritan Hospital","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Professional Component","code":"26","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Blue Access Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Centene","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthlink","plan_name":"Anthem Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"PHCS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Orschein","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Access","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Providers Partners Healthplan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Samaritan Hospital","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Reduced Services","code":"52","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Blue Access Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Centene","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthlink","plan_name":"Anthem Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"PHCS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Orschein","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Access","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Providers Partners Healthplan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Samaritan Hospital","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital","code":"PN","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Blue Access Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Centene","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthlink","plan_name":"Anthem Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"PHCS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Orschein","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Access","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Providers Partners Healthplan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Samaritan Hospital","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery","code":"AS","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Blue Access Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Centene","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthlink","plan_name":"Anthem Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"PHCS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Orschein","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Access","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Providers Partners Healthplan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Samaritan Hospital","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha","code":"TC","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Blue Access Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Centene","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthlink","plan_name":"Anthem Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"PHCS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Orschein","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Access","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Providers Partners Healthplan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Samaritan Hospital","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Modifier description not available","code":"93","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Blue Access Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Centene","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthlink","plan_name":"Anthem Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"PHCS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Orschein","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Access","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Providers Partners Healthplan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Samaritan Hospital","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Assistant Surgeon","code":"80","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Blue Access Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Centene","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthlink","plan_name":"Anthem Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"PHCS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Orschein","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Access","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Providers Partners Healthplan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Samaritan Hospital","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Clia waived test","code":"QW","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Blue Access Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Centene","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthlink","plan_name":"Anthem Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"PHCS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Orschein","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Access","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Providers Partners Healthplan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Samaritan Hospital","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient physical therapy plan of care","code":"GP","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Ins Texas","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Medicare Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Of Tn","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"American Health Advantage Of Tn","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup Claims Dept","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerivantage Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs Specialty Pharmacy","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Advantage Mcare Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Care Tn Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Preferred","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Select","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bluecare Plus Mcare Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Breast And Cervical Cancer","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cca Centurion Of Tennessee","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cca Core Civic","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Champva","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Healthspring","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Medicare Access","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna St Of Tn","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cover Kids Tn Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Choice Care","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Gold Plus","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Insurance","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tenncare Select Tn Tn Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Community Plan Tn Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Dual Complete","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Heritage","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Medicare Solutions","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Choice Plus","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Mcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Veterans Affairs Med Ctr","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Veterans Evaluation Servi","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellpoint","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellpoint Advantage","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Left side (used to identify procedures performed on the left side of the body)","code":"LT","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Ins Texas","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Medicare Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Of Tn","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"American Health Advantage Of Tn","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup Claims Dept","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerivantage Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs Specialty Pharmacy","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Advantage Mcare Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Care Tn Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Preferred","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Select","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bluecare Plus Mcare Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Breast And Cervical Cancer","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cca Centurion Of Tennessee","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cca Core Civic","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Champva","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Healthspring","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Medicare Access","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna St Of Tn","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cover Kids Tn Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Choice Care","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Gold Plus","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Insurance","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tenncare Select Tn Tn Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Community Plan Tn Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Dual Complete","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Heritage","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Medicare Solutions","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Choice Plus","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Mcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Veterans Affairs Med Ctr","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Veterans Evaluation Servi","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellpoint","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellpoint Advantage","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Right side (used to identify procedures performed on the right side of the body)","code":"RT","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Ins Texas","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Medicare Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Of Tn","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"American Health Advantage Of Tn","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup Claims Dept","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerivantage Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs Specialty Pharmacy","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Advantage Mcare Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Care Tn Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Preferred","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Select","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bluecare Plus Mcare Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Breast And Cervical Cancer","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cca Centurion Of Tennessee","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cca Core Civic","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Champva","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Healthspring","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Medicare Access","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna St Of Tn","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cover Kids Tn Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Choice Care","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Gold Plus","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Insurance","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tenncare Select Tn Tn Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Community Plan Tn Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Dual Complete","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Heritage","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Medicare Solutions","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Choice Plus","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Mcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Veterans Affairs Med Ctr","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Veterans Evaluation Servi","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellpoint","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellpoint Advantage","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Bilateral Procedure","code":"50","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Ins Texas","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Medicare Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Of Tn","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"American Health Advantage Of Tn","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup Claims Dept","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerivantage Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs Specialty Pharmacy","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Advantage Mcare Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Care Tn Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Preferred","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Select","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bluecare Plus Mcare Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Breast And Cervical Cancer","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cca Centurion Of Tennessee","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cca Core Civic","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Champva","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Healthspring","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Medicare Access","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna St Of Tn","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cover Kids Tn Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Choice Care","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Gold Plus","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Insurance","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tenncare Select Tn Tn Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Community Plan Tn Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Dual Complete","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Heritage","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Medicare Solutions","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Choice Plus","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Mcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Veterans Affairs Med Ctr","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Veterans Evaluation Servi","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellpoint","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellpoint Advantage","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient occupational therapy plan of care","code":"GO","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Ins Texas","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Medicare Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Of Tn","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"American Health Advantage Of Tn","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup Claims Dept","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerivantage Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs Specialty Pharmacy","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Advantage Mcare Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Care Tn Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Preferred","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Select","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bluecare Plus Mcare Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Breast And Cervical Cancer","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cca Centurion Of Tennessee","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cca Core Civic","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Champva","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Healthspring","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Medicare Access","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna St Of Tn","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cover Kids Tn Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Choice Care","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Gold Plus","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Insurance","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tenncare Select Tn Tn Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Community Plan Tn Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Dual Complete","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Heritage","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Medicare Solutions","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Choice Plus","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Mcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Veterans Affairs Med Ctr","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Veterans Evaluation Servi","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellpoint","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellpoint Advantage","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient speech language pathology plan of care","code":"GN","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Ins Texas","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Medicare Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Of Tn","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"American Health Advantage Of Tn","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup Claims Dept","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerivantage Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs Specialty Pharmacy","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Advantage Mcare Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Care Tn Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Preferred","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Select","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bluecare Plus Mcare Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Breast And Cervical Cancer","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cca Centurion Of Tennessee","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cca Core Civic","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Champva","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Healthspring","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Medicare Access","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna St Of Tn","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cover Kids Tn Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Choice Care","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Gold Plus","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Insurance","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tenncare Select Tn Tn Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Community Plan Tn Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Dual Complete","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Heritage","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Medicare Solutions","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Choice Plus","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Mcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Veterans Affairs Med Ctr","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Veterans Evaluation Servi","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellpoint","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellpoint Advantage","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional","code":"76","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Ins Texas","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Medicare Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Of Tn","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"American Health Advantage Of Tn","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup Claims Dept","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerivantage Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs Specialty Pharmacy","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Advantage Mcare Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Care Tn Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Preferred","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Select","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bluecare Plus Mcare Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Breast And Cervical Cancer","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cca Centurion Of Tennessee","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cca Core Civic","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Champva","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Healthspring","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Medicare Access","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna St Of Tn","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cover Kids Tn Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Choice Care","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Gold Plus","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Insurance","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tenncare Select Tn Tn Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Community Plan Tn Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Dual Complete","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Heritage","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Medicare Solutions","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Choice Plus","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Mcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Veterans Affairs Med Ctr","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Veterans Evaluation Servi","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellpoint","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellpoint Advantage","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Reduced Services","code":"52","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Ins Texas","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Medicare Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Of Tn","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"American Health Advantage Of Tn","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup Claims Dept","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerivantage Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs Specialty Pharmacy","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Advantage Mcare Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Care Tn Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Preferred","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Select","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bluecare Plus Mcare Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Breast And Cervical Cancer","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cca Centurion Of Tennessee","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cca Core Civic","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Champva","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Healthspring","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Medicare Access","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna St Of Tn","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cover Kids Tn Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Choice Care","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Gold Plus","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Insurance","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tenncare Select Tn Tn Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Community Plan Tn Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Dual Complete","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Heritage","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Medicare Solutions","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Choice Plus","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Mcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Veterans Affairs Med Ctr","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Veterans Evaluation Servi","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellpoint","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellpoint Advantage","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Repeat Clinical Diagnostic Laboratory Test","code":"91","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Ins Texas","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Medicare Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Of Tn","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"American Health Advantage Of Tn","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup Claims Dept","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerivantage Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs Specialty Pharmacy","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Advantage Mcare Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Care Tn Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Preferred","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Select","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bluecare Plus Mcare Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Breast And Cervical Cancer","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cca Centurion Of Tennessee","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cca Core Civic","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Champva","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Healthspring","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Medicare Access","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna St Of Tn","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cover Kids Tn Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Choice Care","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Gold Plus","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Insurance","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tenncare Select Tn Tn Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Community Plan Tn Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Dual Complete","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Heritage","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Medicare Solutions","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Choice Plus","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Mcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Veterans Affairs Med Ctr","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Veterans Evaluation Servi","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellpoint","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellpoint Advantage","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha","code":"TC","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Ins Texas","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Medicare Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Of Tn","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"American Health Advantage Of Tn","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup Claims Dept","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerivantage Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs Specialty Pharmacy","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Advantage Mcare Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Care Tn Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Preferred","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Select","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bluecare Plus Mcare Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Breast And Cervical Cancer","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cca Centurion Of Tennessee","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cca Core Civic","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Champva","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Healthspring","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Medicare Access","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna St Of Tn","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cover Kids Tn Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Choice Care","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Gold Plus","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Insurance","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tenncare Select Tn Tn Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Community Plan Tn Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Dual Complete","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Heritage","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Medicare Solutions","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Choice Plus","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Mcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Veterans Affairs Med Ctr","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Veterans Evaluation Servi","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellpoint","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellpoint Advantage","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Distinct Procedural Service","code":"59","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Ins Texas","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Medicare Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Of Tn","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"American Health Advantage Of Tn","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup Claims Dept","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerivantage Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs Specialty Pharmacy","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Advantage Mcare Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Care Tn Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Preferred","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Select","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bluecare Plus Mcare Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Breast And Cervical Cancer","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cca Centurion Of Tennessee","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cca Core Civic","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Champva","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Healthspring","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Medicare Access","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna St Of Tn","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cover Kids Tn Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Choice Care","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Gold Plus","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Insurance","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tenncare Select Tn Tn Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Community Plan Tn Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Dual Complete","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Heritage","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Medicare Solutions","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Choice Plus","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Mcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Veterans Affairs Med Ctr","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Veterans Evaluation Servi","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellpoint","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellpoint Advantage","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Outpatient occupational therapy services furnished in whole or in part by an occupational therapy assistant","code":"CO","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Ins Texas","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Medicare Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Of Tn","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"American Health Advantage Of Tn","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup Claims Dept","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerivantage Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs Specialty Pharmacy","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Advantage Mcare Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Care Tn Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Preferred","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Select","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bluecare Plus Mcare Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Breast And Cervical Cancer","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cca Centurion Of Tennessee","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cca Core Civic","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Champva","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Healthspring","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Medicare Access","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna St Of Tn","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cover Kids Tn Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Choice Care","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Gold Plus","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Insurance","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tenncare Select Tn Tn Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Community Plan Tn Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Dual Complete","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Heritage","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Medicare Solutions","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Choice Plus","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Mcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Veterans Affairs Med Ctr","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Veterans Evaluation Servi","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellpoint","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellpoint Advantage","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Outpatient physical therapy services furnished in whole or in part by a physical therapist assistant","code":"CQ","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Ins Texas","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Medicare Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Of Tn","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"American Health Advantage Of Tn","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup Claims Dept","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerivantage Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs Specialty Pharmacy","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Advantage Mcare Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Care Tn Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Preferred","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Select","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bluecare Plus Mcare Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Breast And Cervical Cancer","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cca Centurion Of Tennessee","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cca Core Civic","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Champva","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Healthspring","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Medicare Access","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna St Of Tn","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cover Kids Tn Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Choice Care","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Gold Plus","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Insurance","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tenncare Select Tn Tn Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Community Plan Tn Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Dual Complete","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Heritage","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Medicare Solutions","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Choice Plus","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Mcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Veterans Affairs Med Ctr","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Veterans Evaluation Servi","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellpoint","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellpoint Advantage","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service","code":"XU","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Ins Texas","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Medicare Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Of Tn","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"American Health Advantage Of Tn","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup Claims Dept","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerivantage Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs Specialty Pharmacy","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Advantage Mcare Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Care Tn Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Preferred","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Select","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bluecare Plus Mcare Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Breast And Cervical Cancer","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cca Centurion Of Tennessee","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cca Core Civic","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Champva","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Healthspring","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Medicare Access","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna St Of Tn","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cover Kids Tn Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Choice Care","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Gold Plus","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Insurance","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tenncare Select Tn Tn Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Community Plan Tn Medicaid","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Dual Complete","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Heritage","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Uhc Medicare Solutions","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Choice Plus","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Mcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Va Ccn Optum","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Veterans Affairs Med Ctr","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Veterans Evaluation Servi","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellpoint","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellpoint Advantage","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Outpatient physical therapy services furnished in whole or in part by a physical therapist assistant","code":"CQ","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Georgia Assurance","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Choice Care Leased Network All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Secure Health Plan","plan_name":"Leased Network PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","description":"The modified price is presented in the standard charge value."}]},{"description":"Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the same day of the Procedure or Other Service","code":"25","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Georgia Assurance","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Choice Care Leased Network All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Secure Health Plan","plan_name":"Leased Network PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","description":"The modified price is presented in the standard charge value."}]},{"description":"Distinct Procedural Service","code":"59","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Georgia Assurance","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Choice Care Leased Network All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Secure Health Plan","plan_name":"Leased Network PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","description":"The modified price is presented in the standard charge value."}]},{"description":"Left side (used to identify procedures performed on the left side of the body)","code":"LT","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Georgia Assurance","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Choice Care Leased Network All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Secure Health Plan","plan_name":"Leased Network PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","description":"The modified price is presented in the standard charge value."}]},{"description":"Right side (used to identify procedures performed on the right side of the body)","code":"RT","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Georgia Assurance","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Choice Care Leased Network All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Secure Health Plan","plan_name":"Leased Network PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","description":"The modified price is presented in the standard charge value."}]},{"description":"Left anterior descending coronary artery","code":"LD","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Georgia Assurance","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Choice Care Leased Network All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Secure Health Plan","plan_name":"Leased Network PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","description":"The modified price is presented in the standard charge value."}]},{"description":"Left circumflex coronary artery","code":"LC","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Georgia Assurance","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Choice Care Leased Network All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Secure Health Plan","plan_name":"Leased Network PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","description":"The modified price is presented in the standard charge value."}]},{"description":"Right coronary artery","code":"RC","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Georgia Assurance","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Choice Care Leased Network All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Secure Health Plan","plan_name":"Leased Network PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","description":"The modified price is presented in the standard charge value."}]},{"description":"Ramus intermedius coronary artery","code":"RI","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Georgia Assurance","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Choice Care Leased Network All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Secure Health Plan","plan_name":"Leased Network PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","description":"The modified price is presented in the standard charge value."}]},{"description":"Left main coronary artery","code":"LM","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Georgia Assurance","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Choice Care Leased Network All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Secure Health Plan","plan_name":"Leased Network PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","description":"The modified price is presented in the standard charge value."}]},{"description":"Separate structure, a service that is distinct because it was performed on a separate organ/structure","code":"XS","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"HMO/POS/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HMO/POS/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Georgia Assurance","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Choice Care Leased Network All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Secure Health Plan","plan_name":"Leased Network PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/POS/PPO","description":"The modified price is presented in the standard charge value."}]}]}